MS. Kristina Lawrence Wall, MEDICAID WAIVER PROV

NPI #1790822682 in Deltona, Florida

Provider Information

NPI Number: 1790822682
Entity Type: Individual
Name: MS. Kristina Lawrence Wall, MEDICAID WAIVER PROV
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Specialist
Credential: MEDICAID WAIVER PROV
Enumeration Date: Jan 31, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 151 HUMMINGBIRD ST APT B
City: Deltona
State: Florida
ZIP Code: 32725-8059
Phone: (386) 216-3317

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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