| NPI | 1366100802 |
|---|---|
| Former Name | EMILY CLARK WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024188752) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001270316) |
| Enumeration Date | 2021-12-01 |
| Last Update Date | 2023-12-21 |