Provider Demographics
NPI:1710654744
Name:WALLS, DONNIETRA LA'VERNE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:DONNIETRA
Middle Name:LA'VERNE
Last Name:WALLS
Suffix:
Gender:F
Credentials:AGACNP-BC
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Mailing Address - Street 1:1201 E MICHIGAN AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1855
Mailing Address - Country:US
Mailing Address - Phone:517-205-1591
Mailing Address - Fax:517-782-1713
Practice Address - Street 1:1201 E MICHIGAN AVE STE 240
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1855
Practice Address - Country:US
Practice Address - Phone:517-205-1591
Practice Address - Fax:517-782-1713
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2023-10-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI2021034592363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care