Provider Demographics
NPI:1669752481
Name:WALLIS, MEREDITH M (CNM, ANP)
Entity type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:M
Last Name:WALLIS
Suffix:
Gender:F
Credentials:CNM, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:418 HARRIS ST
Mailing Address - Street 2:STE. 316
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1083
Mailing Address - Country:US
Mailing Address - Phone:505-681-7769
Mailing Address - Fax:877-299-7953
Practice Address - Street 1:418 HARRIS ST
Practice Address - Street 2:STE. 316
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1083
Practice Address - Country:US
Practice Address - Phone:505-681-7769
Practice Address - Fax:877-299-7953
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK1247367A00000X, 363LW0102X
AK33265163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse