Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | 26NJ00343800 | NJ |
NPI | 1063794659 |
---|---|
Provider Name | Ms. Sarah Wallis |
First Address | Bridgewater, NJ 08807-1915 |
Second Address | Scotch Plains, NJ 07076-1751 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2011 |
Last Update Date | 16/12/2016 |