Provider Demographics
NPI:1043834781
Name:WALL, NATALIE (MD)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:
Last Name:WALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 E BRICKYARD RD APT 343
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-5623
Mailing Address - Country:US
Mailing Address - Phone:480-313-3518
Mailing Address - Fax:
Practice Address - Street 1:VCUHS DEPT OF SURGERY RESIDENCY, 980645
Practice Address - Street 2:1250 E. MARSHALL STREET
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0645
Practice Address - Country:US
Practice Address - Phone:804-828-7874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program