Individual
MS. LISA MARIE WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
659 E 5TH ST, SHERIDAN, WY 82801-3101
(307) 751-9624
Mailing address
659 E 5TH ST, SHERIDAN, WY 82801-3101
(307) 751-9624
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN30652
MT
Other
Enumeration date
02/23/2013
Last updated
02/23/2013
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