Individual
ELIZABETH NICOLE WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1937 S BURNSIDE AVE, GONZALES, LA 70737-4632
(225) 765-5500
(225) 644-9286
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(225) 765-5500
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
331615
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
LA
Other
Enumeration date
04/11/2019
Last updated
04/11/2023
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