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Individual
KATHRYN MARY WALLACE
Active
Individual
KATHRYN MARY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, BC
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71000473A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200056120A
—
IN
01
—
500004228
RAILROAD MEDICARE
IN
Enumeration date
08/30/2006
Last updated
09/17/2012
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