Provider Demographics
NPI:1063786580
Name:WALSEN, INGEBORG J (CNMT, NCT, RT(N)(CT))
Entity type:Individual
Prefix:MS
First Name:INGEBORG
Middle Name:J
Last Name:WALSEN
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Gender:F
Credentials:CNMT, NCT, RT(N)(CT)
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Mailing Address - Street 1:2360 E PERSHING BLVD
Mailing Address - Street 2:VA MEDICAL CENTER, ATTN: NUC MED
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-5356
Mailing Address - Country:US
Mailing Address - Phone:307-778-7550
Mailing Address - Fax:
Practice Address - Street 1:2360 E PERSHING BLVD
Practice Address - Street 2:VA MEDICAL CENTER, ATTN: NUC MED
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5356
Practice Address - Country:US
Practice Address - Phone:307-778-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2012-05-07
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Provider Licenses
StateLicense IDTaxonomies
UT7403884-54012471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine Technology