| Doctor Name: | TRAM T WALLEN |
| NPI Number: | 1023252707 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | WHNP |
| License Number: | 2004020175 |
| Business Practice Address: | 102 Grande Ctr Sullivan, MO - 630801266 |
| Business Phone Number: | 5734684455 |
| Business Fax Number: | 5734684451 |
| Mailing Address: | 901 Patients First Dr, WASHINGTON |
| State: | MO |
| Postal Code: | 630904700 |
| Phone Number: | 6363901400 |
| Fax Number: | 6362395166 |
| NPI Enumeration Date: | 04/27/2009 |
| NPI Last Update Date: | 04/27/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LW0102X |
| License Number: | 2004020175 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Women's Health |
| Taxonomy Definition: | |