Individual provider · NPI-1

Stephanie Ann Wall, CSA

Specialist/Technologist, Other, Surgical Assistant · Bowie, MD

NPI number1003140278

StatusActive

Last updated in NPPESMar 22, 2017

Details

NPI: 1003140278
Entity type: Individual (NPI-1)
Name: Stephanie Ann Wall
Credential: CSA
Sex: Female
Sole proprietor: No
Enumeration date: Sep 22, 2009
Last updated: Mar 22, 2017

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
246ZC0007X	Specialist/Technologist, Other, Surgical Assistant	SA0057	DC	Yes

Practice location

14909 Health Center Dr
359
Bowie, MD 20716-1007

Phone 240-308-0809

Mailing address

14909 Health Center Dr
359
Bowie, MD 20716-1007

Phone 240-308-0809

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.