Healthcare Provider Details

I. General information

NPI: 1043834781
Provider Name (Legal Business Name): NATALIE WALL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VCUHS DEPT OF SURGERY RESIDENCY, 980645 1250 E. MARSHALL STREET
RICHMOND VA
23298-0645
US

IV. Provider business mailing address

1243 E BRICKYARD RD APT 343
SALT LAKE CITY UT
84106-5623
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-7874
  • Fax:
Mailing address:
  • Phone: 480-313-3518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: