National Provider Identifier Database

DANE VANDER WALL, ND – NPI #1053190348
Medical Specialty

An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).


Contact Information

DANE VANDER WALL, ND
9757 W ARNOLD RD
BOISE, ID83714-8210
Phone: 720-220-5331
Fax:
Website:
Specialty Taxonomy Code
* Medical Specialty 261QM2500X

* Indicates primary specialty

NPI Profile & details for DANE VANDER WALL

NPI Number 1053190348
Credentials ND
Entity Individual
Enumeration date 09/26/2023
Last updated 09/26/2023 - About 3 years ago
Sole proprietor1 Yes
Identifiers n/a
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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