Provider Demographics
NPI:1710207055
Name:WALLEN, CHRISTY ANNE (CPD, CD, CPDT,)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:ANNE
Last Name:WALLEN
Suffix:
Gender:F
Credentials:CPD, CD, CPDT,
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:CHRISTY
Other - Last Name:WRIGHT-JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1453 PEITZ AVE
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-1175
Mailing Address - Country:US
Mailing Address - Phone:952-992-9995
Mailing Address - Fax:
Practice Address - Street 1:1453 PEITZ AVE
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1175
Practice Address - Country:US
Practice Address - Phone:952-992-9995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula