Provider Demographics
NPI:1710966163
Name:WALLS, STEVEN E (FNP)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:E
Last Name:WALLS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 S COLUMBIAN WAY
Mailing Address - Street 2:MAILSTOP: S-123-PORT
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1532
Mailing Address - Country:US
Mailing Address - Phone:360-565-9330
Mailing Address - Fax:360-457-0618
Practice Address - Street 1:1005 GEORGIANA ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3917
Practice Address - Country:US
Practice Address - Phone:360-565-9330
Practice Address - Fax:360-457-0618
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN-075019363LF0000X
WAAP06347818363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ194267Medicaid
AZR13870Medicare UPIN
AZ103650Medicare PIN