| NPI | 1790736064 |
|---|---|
| Former Name | BRANDY L WALLIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-02176) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 02176) |
| 363AM0700X Physician Assistant, Medical (Licence: AZ 2097) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2020-11-04 |