Provider Demographics
NPI:1104425461
Name:WALLS, CAMMI ANN KASSIE (RN)
Entity type:Individual
Prefix:
First Name:CAMMI
Middle Name:ANN KASSIE
Last Name:WALLS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MOSSRIDGE
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3516
Mailing Address - Country:US
Mailing Address - Phone:360-477-2634
Mailing Address - Fax:
Practice Address - Street 1:105 MOSSRIDGE
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3516
Practice Address - Country:US
Practice Address - Phone:360-477-2634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1015876163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics