Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 209.018941 | IL |
NPI | 1053970558 |
---|---|
Provider Name | Trinity Walls |
First Address | Matteson, IL 60443-4014 |
Second Address | Hammond, IN 46324-2220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2019 |
Last Update Date | 07/06/2019 |