| NPI | 1669983789 |
|---|---|
| Former Name | ELIZABETH L WALL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.016146) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.402814) |
| Enumeration Date | 2017-10-16 |
| Last Update Date | 2020-12-09 |