Provider Demographics
NPI:1437699717
Name:WALLS, MEGHAN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:WALLS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WIND RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4173
Mailing Address - Country:US
Mailing Address - Phone:715-847-2611
Mailing Address - Fax:715-847-2665
Practice Address - Street 1:500 WIND RIDGE DR
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4173
Practice Address - Country:US
Practice Address - Phone:715-847-2611
Practice Address - Fax:715-847-2665
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704267947163W00000X, 363LF0000X
WI243532-30163W00000X
WI8607-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse