# MS. LORI LYNNE WALLACE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1548411523
- **Gender:** F
- **Credential:** LPN, RCS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 164W00000X | Licensed Practical Nurse | 309826031 | WI | Yes |

## Other

- **Enumeration date:** 10/08/2008
- **Last updated:** 10/08/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 35061000 | — | WI |