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1760426258
MATTHEW EDWIN WALLACE
OMAHA, NE
NPI
1760426258
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: NE 378)
Enumeration Date
2006-06-15
Last Update Date
2007-07-08
Business Address
Mr. MATTHEW EDWIN WALLACE ATC, PES
CREIGHTON UNIUVERSITY 2500 CALIFORNIA PLAZA
OMAHA, NE 68178-0001
Phone number: 402-280-5563
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Mailing Address
Mr. MATTHEW EDWIN WALLACE ATC, PES
2932 S 93RD PLZ APT. 5
OMAHA, NE 68124-2823
Phone number: 402-990-4004
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