Individual
DEANNA LORRAINE WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
USA MEDDAC EVANS ARMY COMMUNITY HOSPITAL, PACL SDS, FORT CARSON, CO 80913-4604
(719) 526-7071
(719) 526-7007
Mailing address
1650 COCHRANE CIRCLE, DEPARTMENT OF THE ARMY USA MEDDAC EVANS ARMY COMMUNITY, FT CARSON, CO 80913-4604
(719) 526-7649
(719) 526-7019
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN135981
GA
Other
Enumeration date
07/11/2006
Last updated
07/08/2007
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