Walla, Susan P

Walla, Susan P is an sole proprietor health care provider with primary practice located at 707 W 8Th St , Gillette WY 82716-4108. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as her primary health care specialty. Walla, Susan P can be contacted via phone (307) 685-8255.

Contact Information

Primary practice address
707 W 8Th St Gillette WY 82716-4108
Phone: (307) 685-8255
Fax: (888) 852-8319
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 21112 Montana
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 29650.1122 Wyoming

Profile Details

NPI number 1962589747
LBN Legal business name Walla, Susan P
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 1st, 2006
Last updated Aug 24th, 2016 - about 9 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962589747 NPPES
Montana MEDICAID 0000439212
Montana MEDICAID 136049300

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