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General NPI Number Information
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NPI Number | 1538958574
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Entity Type | Organization
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Legal Business Name | WALLISER MEDICAL CENTER LLC
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 9380 BRADMORE LANE STE 104
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City | OOLTEWAH
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State | TN
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Zip | 37363-4447
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Country | US
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Telephone | 423-760-4630
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Fax | 423-760-4631
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Provider Business Mailing Address
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Address Line | 9380 BRADMORE LANE STE 104
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City | OOLTEWAH
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State | TN
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Zip | 37363-4447
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Country | US
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Telephone | 423-760-4630
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Fax | 423-760-4631
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MRS. LAUREN WALLISER
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Credential | FNP-C
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Telephone | 423-760-9630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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