MRS. NANCY WALLER (NPI# 1093982647) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093982647 |
| Entity Type | Individual |
| Full Name | MRS. NANCY WALLER |
| Credential | PA |
| Practice Address |
1339 S Pueblo Blvd Pueblo CO 81005-1508 |
| Practice Telephone | 7196475831 |
| Practice Fax Number | 7196475833 |
| Mailing Telephone | 7196475831 |
| Mailing Fax Number | 7196475833 |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2008-05-13 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
120 | CO | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487707618 | Nancy Jane Waller | Registered Nurse | 10940 Sw Barnes Rd, Pmb 261, Portland, OR 97225-5368 | 2007-01-19 |
| 1972602035 | Nancy Waller | Social Worker | 3037 Nw 63rd St, Ste 104, Oklahoma City, OK 73116-3637 | 2006-09-22 |
| 1508833419 | Nancy Waller | Pediatrics | 701 25th Ave S, #306, Minneapolis, MN 55454-1513 | 2006-03-01 |
| Street Address |
1339 S PUEBLO BLVD |
| City | PUEBLO |
| State | CO |
| Zip Code | 81005-1508 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992973473 | Richard Rivera Mdpc | Clinic/Center | 1339 S Pueblo Blvd, Pueblo, CO 81005-1686 | 2008-02-18 |
| 1396035887 | Boone Guest Home | Foster Care Agency | 1339 S Pueblo Blvd, Pueblo, CO 81005-1686 | 2011-04-18 |
| 1114164795 | Sally Gonzales-apodaca | Physician Assistant | 1339 S Pueblo Blvd, Pueblo, CO 81005-1686 | 2009-01-19 |
| 1780821991 | Richard Rivera Mdpc | Clinic/Center | 1339 S Pueblo Blvd, Pueblo, CO 81005-1686 | 2009-01-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225595630 | Kimberly Warfield | Specialist | 5825 W Hwy 78, Pueblo, CA 81005 | 2019-02-22 |
| 1417461823 | Yah Vision | Optometrist | 2568 Taylor Ln, Pueblo, CO 81005 | 2017-11-21 |
| 1245758168 | Jenny C Alas | Dentist | 2603 Vinewood Lane, Pueblo, CO 81005 | 2017-08-30 |
| 1801342472 | Cynthia Watson | Counselor | 2429 S. Prairie Avenue, Pueblo, CO 81005 | 2016-09-01 |
| 1598033664 | Kyle Andrew Bonds | Pharmacist | 2900 W. Northern Ave., Pueblo, CO 81005 | 2011-12-05 |
| 1346406196 | Samantha Coleman | Counselor | 2429 S Prairie Ave, Pueblo, CO 81005 | 2008-07-31 |
| 1184890915 | Hg Stringert Dds, Ms, PC | Dentist | 3955 Sandlewood Lane, Pueblo, CO 81005 | 2008-05-01 |
| 1992902423 | David Russell Baer | Dentist | 2041 Pepper Lane, Ste A, Pueblo, CO 81005 | 2007-06-28 |
| 1659443695 | Thomas Wesley Ready | Dentist | 643 So Pueblo Blvd, Pueblo, CO 81005 | 2006-11-14 |
| 1700969029 | Bradley Michael Almond | Dentist | 1221 S Pueblo Blvd, Pueblo, CO 81005 | 2006-10-23 |
| Find all providers in zip 81005 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356685747 | Dayna Rae Hochevar | Physician Assistant | 602 Brown Ave, Pueblo, CO 81004 | 2012-11-26 |
| 1164584686 | Michael S Walsh | Physician Assistant | 3116 N. Elizabeth, Pueblo, CO 81008 | 2006-12-14 |
| 1669033973 | Shelby Subry | Physician Assistant | 400 W 16th St, Pueblo, CO 81003-2745 | 2019-06-26 |
| 1003342981 | Vi T Pham | Physician Assistant | 1080 Chinook Ln, Pueblo, CO 81001-1850 | 2017-05-11 |
| 1679922777 | Gary Anthony Serravo | Physician Assistant | 400 W 16th St, Pueblo, CO 81003-2745 | 2016-06-09 |
| 1588057319 | James Richard Anderson | Physician Assistant | 3676 Parker Blvd, Pueblo, CO 81008-2212 | 2015-03-18 |
| 1285040196 | Brittany Stadterman | Physician Assistant | 300 Colorado Ave, Pueblo, CO 81004-2006 | 2014-07-11 |
| 1023342961 | Juan Carlos Herraez Sanchez | Physician Assistant | 1008 Minnequa Ave, Pueblo, CO 81004-3733 | 2009-09-24 |
| 1083869754 | Ginger Rae Todd | Physician Assistant | 300 Colorado Ave, Pueblo, CO 81004-2006 | 2008-11-22 |
| 1659542926 | Marc A Williams | Physician Assistant | 1600 N Grand Ave Ste 310, Pueblo, CO 81003-2729 | 2008-03-14 |
| Find all providers in PUEBLO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.