| NPI | 1013349000 |
|---|---|
| Other Name | LISA MARIE WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 28748) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH NP-14866) |
| Enumeration Date | 2013-08-01 |
| Last Update Date | 2024-09-13 |