Doctor Name: | MRS. GLORIA AGNES WALL |
NPI Number: | 1386846657 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN |
License Number: | 50568-30 |
Business Practice Address: | 225 N Beaumont Rd Suite 306 Prairie Du Chien, WI - 538211445 |
Business Phone Number: | 6083260230 |
Business Fax Number: | 6083260289 |
Mailing Address: | 225 N Beaumont Rd, Suite 306 PRAIRIE DU CHIEN |
State: | WI |
Postal Code: | 538211445 |
Phone Number: | 6083260230 |
Fax Number: | 6083260289 |
NPI Enumeration Date: | 05/31/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WC1500X |
License Number: | 50568-30 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Community Health |
Taxonomy Definition: |