Provider Demographics
NPI:1174827968
Name:WALLA, AMBER CASSADAY (CPM)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:CASSADAY
Last Name:WALLA
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9007 W 70TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-1110
Mailing Address - Country:US
Mailing Address - Phone:816-914-9551
Mailing Address - Fax:
Practice Address - Street 1:9007 W 70TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-1110
Practice Address - Country:US
Practice Address - Phone:816-914-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife