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1407965320
KATHRYN MARY WALLACE
PORTAGE, IN
NPI
1407965320
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363L00000X Nurse Practitioner
(Licence: IN 71000473A)
Enumeration Date
2006-08-30
Last Update Date
2012-09-17
Business Address
-- KATHRYN MARY WALLACE APRN, BC
2640 HAMSTROM RD
PORTAGE, IN 46368-3832
Phone number: 219-762-4423
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Mailing Address
-- KATHRYN MARY WALLACE APRN, BC
2640 HAMSTROM RD
PORTAGE, IN 46368-3832
Phone number: 219-762-4423
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