Individual
SUSAN DALE WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
521 WESTBURY DR STE 2, IOWA CITY, IA 52245-2727
(319) 339-3872
(319) 339-3874
Mailing address
801 YORK ST, MANITOWOC, WI 54220-4630
(920) 663-9008
(920) 684-1439
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
28400
IA
207NS0135X
Procedural Dermatology Physician
28400
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0079301
—
IA
Enumeration date
01/09/2006
Last updated
06/30/2022
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