| NPI | 1538250618 |
|---|---|
| Former Name | THERESE LYNN WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: IN 71000314A) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH 0038109) |
| 363L00000X Nurse Practitioner (Licence: IN 71000314) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2024-11-14 |