Individual
JOHANNA HENDERSON WALLISA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
702 BARNHILL DR, ROOM 2001, INDIANAPOLIS, IN 46202-5128
(317) 274-9981
Mailing address
4809 MELBOURNE RD, INDIANAPOLIS, IN 46228-2090
(317) 985-5894
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01063488A
IN
Other
Enumeration date
09/08/2008
Last updated
09/08/2008
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