| NPI | 1609130723 |
|---|---|
| Former Name | CRYSTAL J WALLING |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60593113) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 141029) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA ML60296590) | |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2021-12-29 |