| NPI | 1235106840 |
|---|---|
| Former Name | LISA ANN WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA.04992-NA) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3485A) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2017-12-13 |