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General NPI Number Information
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NPI Number | 1972649887
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Entity Type | Individual
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Provider Name | GUY R WALLING NP NURSE PRACTITIONE
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Gender | Male
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 10/08/2018
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Provider Practice Location Address
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Address Line | 5470 EAST 16TH STREET
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City | INDIANAPOLIS
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State | IN
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Zip | 46218-4861
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Country | US
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Telephone | 317-355-5009
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Fax |
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Provider Business Mailing Address
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Address Line | 12617 OLD STONE DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46236-9317
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Country | US
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Telephone | 317-652-1400
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Fax | 317-355-6096
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 71002327A
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License Number State | IN
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