Wall, Philly Marie

Wall, Philly Marie is an individual health care provider with primary practice located at 830 4Th Ave Se Ste 1 , Cedar Rapids IA 52403-2445. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Wall, Philly Marie can be contacted via phone (402) 650-6765.

Contact Information

Primary practice address
830 4Th Ave Se Ste 1 Cedar Rapids IA 52403-2445
Phone: (402) 650-6765
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 001778 Iowa

Profile Details

NPI number 1497894117
LBN Legal business name Wall, Philly Marie
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 6th, 2007
Last updated Nov 18th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497894117 NPPES
Iowa MEDICAID 0188946

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