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1811393648
CYNTHIA WALLACE
MEDFORD, OR
NPI
1811393648
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LG0600X Nurse Practitioner, Gerontology
(Licence: OR 201500016NP-PP)
Enumeration Date
2014-11-05
Last Update Date
2020-09-30
Business Address
Mrs. CYNTHIA WALLACE AGPCNP
1111 CRATER LAKE AVE
MEDFORD, OR 97504-6241
Phone number: 541-732-5250
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Mailing Address
Mrs. CYNTHIA WALLACE AGPCNP
PO BOX 3308
PORTLAND, OR 97208-3308
Phone number: 541-732-5250
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