Waller, Brenda Diane

Waller, Brenda Diane is an individual health care provider with primary practice located at Hwy 160/163 Building Ka 2010 , Kayenta AZ 86033-0368. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Nursing Service Providers / Emergency. Nursing Service Providers / Registered Nurse is her primary health care specialty. Waller, Brenda Diane can be contacted via phone (928) 697-4100.

Contact Information

Primary practice address
Hwy 160/163 Building Ka 2010 Kayenta AZ 86033-0368
Phone: (928) 697-4100
Fax: (928) 697-4029
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X RN0000037956 Tennessee
Nursing Service Providers / Registered Nurse 163W00000X NURR34341 Alaska
Nursing Service Providers / Emergency 163WE0003X 37956 Tennessee
Nursing Service Providers / Emergency 163WE0003X NURR34341 Alaska

Profile Details

NPI number 1104233949
LBN Legal business name Waller, Brenda Diane
Credentials Registered Nurse (RN)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 14th, 2014
Last updated Jul 14th, 2014 - about 10 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 1104233949 NPPES
Arizona MEDICAID 060012

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