| NPI | 1194384560 |
|---|---|
| Former Name | CHELSEA LYN WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: MO 2022012999) |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2026-01-05 |