Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MARY RUTH WALLIS
Active Sole ProprietorMARY RUTH WALLIS is a Licensed Practical Nurse healthcare provider located in EATON, New York. NPI 1790430650 is currently active in the NPPES registry. Verify at CMS.
Licensed Practical Nurse · EATON, NY
Registration Details
- NPI Number
- 1790430650
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Feb 18, 2022 (4.5281881338399 yrs)
- Last Updated
- Feb 18, 2022
- License
-
332738 (NY)
- Sole Proprietor
- Yes
Practice Information
- Address
-
2516 CANDY LN LOT 17EATON, NY, 133343286Browse NY providers · Browse ZIP 13334
- Phone
- 3156791638
- Primary Specialty
-
Licensed Practical Nurse
164W00000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.