MEDICARE: PATTY WALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1306645338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATTY WALL

Provider Business Mailing Address
First Line	:	805 O ST
Second Line	:
City	:	AURORA
State	:	NE
Zip	:	68818-1160
Country	:	US
Telephone Number	:	402-604-1103
Fax Number	:

Provider Business Practice Location Address
First Line	:	2803 LONE TREE LN
Second Line	:
City	:	CENTRAL CITY
State	:	NE
Zip	:	68826-9442
Country	:	US
Telephone Number	:	308-946-2208
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2025
Last Update Date	:	03/11/2025

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Directions to “ PATTY WALL ” Practice Location

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