| NPI | 1487863759 |
|---|---|
| Former Name | COURTNEY DAWN WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2007-07-08 |