Provider Demographics
NPI:1508300922
Name:WALLS, JOANNA OLIVER (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:OLIVER
Last Name:WALLS
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 W ROCKWELL AVE
Mailing Address - Street 2:#100
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7439
Mailing Address - Country:US
Mailing Address - Phone:907-262-7566
Mailing Address - Fax:
Practice Address - Street 1:206 W ROCKWELL AVE
Practice Address - Street 2:#100
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7439
Practice Address - Country:US
Practice Address - Phone:907-262-7566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR888969163W00000X
AK117672163W00000X
MS901842363LF0000X
AK117654363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse