Healthcare Provider Details

I. General information

NPI: 1700343852
Provider Name (Legal Business Name): CINDY LOU WALL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 E LIVINGSTON AVE
COLUMBUS OH
43227-2302
US

IV. Provider business mailing address

1791 ALUM CREEK DR
COLUMBUS OH
43207-1708
US

V. Phone/Fax

Practice location:
  • Phone: 614-252-4941
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.471621
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number167461
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: