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1508476615
ADAM WALLER
WEST FRANKFORT, IL
NPI
1508476615
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
363L00000X Nurse Practitioner
(Licence: IL 209021745)
Enumeration Date
2020-08-04
Last Update Date
2022-05-23
Business Address
ADAM WALLER NP
502 W SAINT LOUIS ST STE 4
WEST FRANKFORT, IL 62896-1968
Phone number: 618-937-3400
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Mailing Address
ADAM WALLER NP
PO BOX 3988
CARBONDALE, IL 62902-3988
Phone number: 618-937-3400
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