Provider Demographics
NPI:1740025295
Name:WALLER, REMONICA LASHA
Entity type:Individual
Prefix:
First Name:REMONICA
Middle Name:LASHA
Last Name:WALLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAWNTE
Other - Middle Name:
Other - Last Name:WALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10842 PROVIDENCE DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-9054
Mailing Address - Country:US
Mailing Address - Phone:945-276-1378
Mailing Address - Fax:
Practice Address - Street 1:10842 PROVIDENCE DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-9054
Practice Address - Country:US
Practice Address - Phone:945-276-1378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide