Wallis, Brenda

Wallis, Brenda is an individual health care provider with primary practice located at 505 S John Redditt Dr , Lufkin TX 75904-3120. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as her primary health care specialty. Wallis, Brenda can be contacted via phone (936) 639-3036.

Contact Information

Primary practice address
505 S John Redditt Dr Lufkin TX 75904-3120
Phone: (936) 639-3036
Fax: (936) 639-3064
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 072151 Texas

Profile Details

NPI number 1477579688
LBN Legal business name Wallis, Brenda
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 14th, 2006
Last updated Mar 5th, 2008 - about 17 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 1477579688 NPPES
Texas Other 84275U BCBS
Texas Other 84279U BCBS

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