Individual
MRS. MEGAN JEAN WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1 BROADWAY STE 100, DENVER, CO 80203-3959
(303) 455-6345
Mailing address
1 BROADWAY STE 100, DENVER, CO 80203-3959
(303) 455-6345
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2987
CO
Other
Enumeration date
06/24/2010
Last updated
06/24/2010
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