| NPI | 1497285696 |
|---|---|
| Former Name | SHALANE BETH WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 245667) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 245667) |
| 363L00000X Nurse Practitioner (Licence: NC 245667) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: NC 245667) | |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2021-02-22 |