| NPI | 1124450697 |
|---|---|
| Former Name | CHELSEA LEIGH WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NY F338031-1) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 620102-1) |
| 163W00000X Registered Nurse (Licence: PA RN648164) | |
| 363LF0000X Nurse Practitioner Family (Licence: PA SP013073) | |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2015-11-13 |