HATTIE WALLACE

PHOENIX, AZ
NPI1164796520
Former NameHATTIE LANE
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy164W00000X Licensed Practical Nurse
(Licence: AZ  LP044351)
Enumeration Date2012-03-02
Last Update Date2012-03-02
Business Address
-- HATTIE WALLACE
14625 S MOUNTAIN PKWY APT 1056
PHOENIX, AZ 85044-7142
Phone number: 602-565-2159
Mailing Address
-- HATTIE WALLACE
14625 S MOUNTAIN PKWY APT 1056
PHOENIX, AZ 85044-7142
Phone number: 602-565-2159
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