KELLY A WALLACE

SAINT LOUIS, MO
NPI1669464350
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy367500000X Nurse Anesthetist, Certified Registered
(Licence: MO  121517)
Enumeration Date2005-08-18
Last Update Date2010-06-29
Business Address
Ms. KELLY A WALLACE CRNA
615 S NEW BALLAS RD SJMMC DEPT OF ANES
SAINT LOUIS, MO 63141-8221
Phone number: 636-386-9224
Mailing Address
Ms. KELLY A WALLACE CRNA
339 CONSORT DR
BALLWIN, MO 63011-4439
Phone number: 636-386-9224
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