Most Relevant Information
Provider Data
| NPI Number: | 1003564881 |
| Provider Name: | CLARENCE WALLS |
| Entity Type: | Individual |
| Taxonomy Code: | 372500000X |
| Specialty: | Chore Provider |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/11/2022 |
| Last Updated: | 03/11/2022 |
Provider Practice Location
47082 OAK CREEK TRCE
HAMMOND
LA
704013641
Practice Location Phone/Fax
| Phone: | 9859567111 |
| Fax: |
Provider Mailing Location
PO BOX 584
NATALBANY
LA
704510584
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |