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1225035504
KATHLEEN WALLACE
MERRILLVILLE, IN
NPI
1225035504
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363L00000X Nurse Practitioner
(Licence: IN 71000826A)
Enumeration Date
2005-07-01
Last Update Date
2022-12-13
Business Address
KATHLEEN WALLACE APN
90 W 86TH AVE
MERRILLVILLE, IN 46410-7086
Phone number: 219-791-1555
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Mailing Address
KATHLEEN WALLACE APN
120 W 22ND ST STE 200
OAK BROOK, IL 60523-1563
Phone number: 630-573-5000
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