| NPI | 1689155764 |
|---|---|
| Former Name | MADISEN CLAIRE WALLACE |
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1017389) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1017389) |
| 363L00000X Nurse Practitioner (Licence: WA pending) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1017389) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 1017389) | |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2020-11-19 |