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1053136317
STACEY WALLACE
KENOSHA, WI
NPI
1053136317
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
163WA0400X Registered Nurse, Addiction (Substance Use Disorder)
(Licence: WI 251425-30)
Enumeration Date
2024-11-20
Last Update Date
2024-11-20
Business Address
STACEY WALLACE RN
3825 39TH AVE STE 120
KENOSHA, WI 53144-2043
Phone number: 262-946-5752
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Mailing Address
STACEY WALLACE RN
3825 39TH AVE STE 120
KENOSHA, WI 53144-2043
Phone number: 262-946-5752
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