Individual
NIKITA WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNIM
Contact information
Practice address
3635 PEBBLE ST, STONECREST, GA 30038-3395
(954) 668-4696
Mailing address
3035 SE MARICAMP RD STE 104-238, OCALA, FL 34471-6201
(954) 668-4696
Taxonomy
Speciality
Code
Description
License number
State
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
—
—
Other
Enumeration date
04/28/2017
Last updated
02/13/2021
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