Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 111039 | NE |
NPI | 1033341276 |
---|---|
Provider Name | Kristina L Wallingford |
First Address | Bennington, NE 68007-1584 |
Second Address | Bennington, NE 68007-1584 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2009 |
Last Update Date | 21/08/2009 |