Individual
MS. ELIZABETH LAUREN WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3400 SPRUCE ST, 100 CENTREX, PHILADELPHIA, PA 19104-4238
(215) 662-3878
Mailing address
3400 SPRUCE ST, 100 CENTREX, PHILADELPHIA, PA 19104-4238
(215) 662-3878
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA060517
PA
Other
Enumeration date
05/29/2019
Last updated
09/17/2019
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