Individual
MS. KRISTINA LAWRENCE WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MEDICAID WAIVER PROV
Contact information
Practice address
151 HUMMINGBIRD ST APT B, DELTONA, FL 32725-8059
(386) 216-3317
Mailing address
151 HUMMINGBIRD ST APT B, DELTONA, FL 32725-8059
(386) 216-3317
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
689432196
FL
Other
Enumeration date
01/31/2007
Last updated
07/08/2007
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