Provider Demographics
NPI:1609583517
Name:WALLEN, ROBERT (PMHNP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:WALLEN
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16620 N 40TH ST STE E1
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3357
Mailing Address - Country:US
Mailing Address - Phone:602-464-9576
Mailing Address - Fax:480-428-0475
Practice Address - Street 1:13331 W INDIAN SCHOOL RD STE B203
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4340
Practice Address - Country:US
Practice Address - Phone:623-269-3990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ282633363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health