Provider Demographics
NPI:1003496266
Name:WALL, ANNA GLYN
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:GLYN
Last Name:WALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2452 RIDGEMONT DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1251
Mailing Address - Country:US
Mailing Address - Phone:205-432-8196
Mailing Address - Fax:
Practice Address - Street 1:2452 RIDGEMONT DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-1251
Practice Address - Country:US
Practice Address - Phone:205-432-8196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-161944163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse