Provider Demographics
NPI:1083316897
Name:WALLS, ROBIN O
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:O
Last Name:WALLS
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 1:1007 CLARINET BLVD E
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-4751
Mailing Address - Country:US
Mailing Address - Phone:574-226-4225
Mailing Address - Fax:
Practice Address - Street 1:1007 CLARINET BLVD E
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-4751
Practice Address - Country:US
Practice Address - Phone:574-514-2891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN14499374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula