| NPI | 1639171671 |
|---|---|
| Former Name | HEATHER LYNN WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: IN 01060694A) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: IN 01060694A) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2017-01-12 |