Individual
NICOLE WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
46 PRINCE ST STE 207, NEW HAVEN, CT 06519-1600
(203) 787-2264
Mailing address
706 GLASTONBURY TPKE, PORTLAND, CT 06480-1025
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
9346
CT
Other
Enumeration date
04/14/2021
Last updated
04/26/2021
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