Wall, Philly Marie
Wall, Philly Marie is an individual health care provider with primary practice located at 830 4Th Ave Se Ste 1 , Cedar Rapids IA 52403-2445. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Wall, Philly Marie can be contacted via phone (402) 650-6765.Contact Information
Primary practice address
830 4Th Ave Se Ste 1
Cedar Rapids IA 52403-2445
Phone: (402) 650-6765
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 001778 | Iowa |
Profile Details
| NPI number | 1497894117 |
|---|---|
| LBN Legal business name | Wall, Philly Marie |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 6th, 2007 |
| Last updated | Nov 18th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1497894117 | NPPES |
| Iowa | MEDICAID | 0188946 |
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