| NPI | 1477264026 |
|---|---|
| Former Name | KLIMBERLY ANN WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2022-12-09 |