Provider Demographics
NPI:1366967499
Name:WALLS, ZAMIKA A
Entity type:Individual
Prefix:MS
First Name:ZAMIKA
Middle Name:A
Last Name:WALLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 HERITAGE LNDG STE 212A
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63303-8491
Mailing Address - Country:US
Mailing Address - Phone:314-795-9336
Mailing Address - Fax:636-477-6368
Practice Address - Street 1:1600 HERITAGE LNDG STE 212A
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63303-8491
Practice Address - Country:US
Practice Address - Phone:314-795-9336
Practice Address - Fax:314-795-9336
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health