| NPI | 1861558835 |
|---|---|
| Former Name | CAYLYNN ANN WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MN 955) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MN R180936-5) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 1809365) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2022-09-13 |