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General NPI Number Information
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NPI Number | 1326620402
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Entity Type | Individual
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Provider Name | DILLAN WALLS
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Gender | Male
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Dates
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Enumeration Date | 04/27/2021
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 24 BARRING PL
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City | PALM COAST
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State | FL
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Zip | 32137-8828
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Country | US
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Telephone | 386-624-1641
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Fax | 386-585-4627
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Provider Business Mailing Address
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Address Line | 24 BARRING PL
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City | PALM COAST
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State | FL
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Zip | 32137-8828
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Country | US
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Telephone | 386-864-3981
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Fax | 386-585-4627
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | W420-172-98-282-0
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License Number State | FL
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