Individual
MS. PHYLLIS B WALLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7611 MAPLE ST, SUITE A1, NEW ORLEANS, LA 70118-5068
(504) 444-5640
Mailing address
7611 MAPLE ST, SUITE A1, NEW ORLEANS, LA 70118-5068
(504) 444-5640
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
019636
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1380661
—
LA
Enumeration date
03/06/2007
Last updated
11/03/2010
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