| NPI | 1306218656 |
|---|---|
| Former Name | LAUREN WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11017239) |
| Additional Taxonomies | 364S00000X Clinical Nurse Specialist (Licence: OH 364S00000X) |
| Enumeration Date | 2015-10-27 |
| Last Update Date | 2022-04-22 |