KATHRYN MARY WALLACE

PORTAGE, IN
NPI1407965320
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363L00000X Nurse Practitioner
(Licence: IN  71000473A)
Enumeration Date2006-08-30
Last Update Date2012-09-17
Business Address
-- KATHRYN MARY WALLACE APRN, BC
2640 HAMSTROM RD
PORTAGE, IN 46368-3832
Phone number: 219-762-4423
Mailing Address
-- KATHRYN MARY WALLACE APRN, BC
2640 HAMSTROM RD
PORTAGE, IN 46368-3832
Phone number: 219-762-4423
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