| Doctor Name: | MS. ELIZABETH ANN WALL |
| NPI Number: | 1639158264 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 087000077N1 |
| Business Practice Address: | 722 South College Avenue College Place, WA - 99324 |
| Business Phone Number: | 5095248023 |
| Business Fax Number: | 5096916317 |
| Mailing Address: | 87 Sullivan Place, WALLA WALLA |
| State: | WA |
| Postal Code: | 99362 |
| Phone Number: | 5095248023 |
| Fax Number: | 5096916317 |
| NPI Enumeration Date: | 01/12/2006 |
| NPI Last Update Date: | 04/05/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 087000077N1 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |