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Individual
LOURDES IVETTE WALLACE
Active
Individual
LOURDES IVETTE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
RN860816
TX
363LA2200X
Adult Health Nurse Practitioner
11670071-4405
UT
363LA2200X
Adult Health Nurse Practitioner
Primary
AP126548
TX
363LG0600X
Gerontology Nurse Practitioner
11670071-4405
UT
363LG0600X
Gerontology Nurse Practitioner
AP126548
TX
Other
Enumeration date
09/18/2014
Last updated
09/03/2020
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