Individual
COLLEEN RAE WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.C.
Contact information
Practice address
3605 MAYFAIR AVE, HIBBING, MN 55746-2923
(218) 262-3441
(218) 362-6989
Mailing address
3605 MAYFAIR AVE, HIBBING, MN 55746-2923
(218) 262-3441
(218) 362-6989
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
R 1069736
MN
Other
Enumeration date
05/04/2006
Last updated
07/11/2013
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