Wallen, Amy Dianna

Wallen, Amy Dianna is an sole proprietor health care provider with primary practice located at 10 Lake Dr , Bonne Terre MO 63628-1820. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Wallen, Amy Dianna can be contacted via phone (573) 271-5317.

Contact Information

Primary practice address
10 Lake Dr Bonne Terre MO 63628-1820
Phone: (573) 271-5317
Fax: (573) 335-6724
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 2015006782 Missouri

Profile Details

NPI number 1831581222
LBN Legal business name Wallen, Amy Dianna
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 23rd, 2015
Last updated Apr 8th, 2024 - about 2 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 1831581222 NPPES
Missouri MEDICAID 420021276

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