Individual
JOANNE M WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
19005 SE 34TH ST, VANCOUVER, WA 98683-1450
(360) 726-6724
(360) 726-6718
Mailing address
426 SW STARK ST FL 9, PORTLAND, OR 97204-2347
(503) 988-5958
(503) 988-4093
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
091000332N2-PNP-PP
OR
363LP2300X
Primary Care Nurse Practitioner
Primary
AP30006123
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022959
—
OR
05
—
22959
—
OR
Enumeration date
03/19/2008
Last updated
03/17/2018
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