STACI L WALL

FORT WAYNE, IN
NPI1629068291
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363L00000X Nurse Practitioner
(Licence: IN  71003769)
Additional Taxonomies163W00000X Registered Nurse
(Licence: IN  28086186)
Enumeration Date2005-10-25
Last Update Date2018-01-31
Business Address
STACI L WALL NP
7988 W JEFFERSON BLVD
FORT WAYNE, IN 46804-4140
Phone number: 260-432-4400
Mailing Address
STACI L WALL NP
2518 E DUPONT RD
FORT WAYNE, IN 46825-1675
Phone number: 260-432-4400