| NPI | 1356662613 |
|---|---|
| Former Name | KIMBERLY J WALL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 4146) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 146514) |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2019-12-03 |