| NPI | 1407298698 |
|---|---|
| Professional Name | KIMBERLY MICHELLE WALLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: IL 043120655) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH 128873) |
| Enumeration Date | 2013-07-29 |
| Last Update Date | 2016-07-21 |