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1003950288
ROBERT WALLACE
JACKSON, TN
NPI
1003950288
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
367500000X Nurse Anesthetist, Certified Registered
(Licence: TN 53447)
Enumeration Date
2007-02-19
Last Update Date
2011-11-04
Business Address
-- ROBERT WALLACE CRNA
367 HOSPITAL BLVD
JACKSON, TN 38305-2080
Phone number: 731-661-2227
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Mailing Address
-- ROBERT WALLACE CRNA
367 HOSPITAL BLVD
JACKSON, TN 38305-2080
Phone number: 731-661-2227
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