Individual
LEAH WALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4201 NORTHRISE DR., LAS CRUCES, NM 88011
(575) 541-7320
(575) 541-7321
Mailing address
505 S MAIN ST STE 249, LAS CRUCES, NM 88001-1243
(575) 527-5884
(575) 527-5886
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
R65983
NM
Other
Enumeration date
12/18/2013
Last updated
12/18/2013
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