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Individual
MADISON WALLACE
Active
Individual
MADISON WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
22760
TN
Other
Enumeration date
07/18/2017
Last updated
04/17/2024
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