Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 29629 | OK |
N | 208000000X | Pediatrician | DR.0056229 | CO |
N | 208000000X | Pediatrician | E-11128 | AR |
Y | 2080P0204X | Pediatric Emergency Doctor | ME141875 | FL |
NPI | 1104138890 |
---|---|
Provider Name | Jennifer Lynn Walls |
First Address | Fort Myers, FL 33902-2147 |
Second Address | Fort Myers, FL 33908-3618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2010 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103693300 | (05) | FL |
224991001 | (05) | AR |