Nikita Waller, CNIM
Specialist/Technologist, Other, Electroneurodiagnostic in Stonecrest, GA. Individual provider (NPI-1).
NPI number1669907507
StatusActive
Last updated in NPPESFeb 13, 2021
Details
- NPI
- 1669907507
- Entity type
- Individual (NPI-1)
- Name
- Nikita Waller
- Credential
- CNIM
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 28, 2017
- Certification date
- Feb 13, 2021
- Last updated
- Feb 13, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 246ZE0600X | Specialist/Technologist, Other, Electroneurodiagnostic | – | – | Yes |
Practice location
3635 Pebble StStonecrest, GA 30038-3395
Phone 954-668-4696
Mailing address
3035 Se Maricamp Rd Ste 104-238Ocala, FL 34471-6201
Phone 954-668-4696
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