Doctor Name: | CHRISTA JO WALL |
NPI Number: | 1588949762 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-BC |
License Number: | 71003894A |
Business Practice Address: | 124 N Jefferson St Reliant Healthcare Hartford City, IN - 473482201 |
Business Phone Number: | 7653478279 |
Business Fax Number: | 7653478287 |
Mailing Address: | 124 N Jefferson St, Reliant Healthcare HARTFORD CITY |
State: | IN |
Postal Code: | 473482201 |
Phone Number: | 7653478279 |
Fax Number: | 7653478287 |
NPI Enumeration Date: | 10/19/2011 |
NPI Last Update Date: | 01/22/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 71003894A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |