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NPI Code Detail

MEDICARE: MRS. ANDREA S. WALL ACNP

MEDICARE: MRS. ANDREA S. WALL ACNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WS0121XPlastic Surgery Registered NurseR31459NM
2363LA2100XAcute Care Nurse PractitionerR0086862OK

General Provider Information

NPI Number : 1043284292
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANDREA S. WALL ACNP
Provider Business Mailing Address
First Line : 10109 E 79TH ST
Second Line :
City : TULSA
State : OK
Zip : 74133-4564
Country : US
Telephone Number : 918-286-5131
Fax Number : 918-249-7532
Provider Business Practice Location Address
First Line : 10109 E 79TH ST
Second Line :
City : TULSA
State : OK
Zip : 74133-4564
Country : US
Telephone Number : 918-286-5131
Fax Number : 918-249-7532
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2006
Last Update Date : 02/22/2013

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