Individual
CINDA LOU WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1101 MOULTON AND PARSONS DR, SAINT JAMES, MN 56081-5550
(507) 375-3261
Mailing address
1025 MARSH ST, MANKATO, MN 56001-4752
(507) 625-4031
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R0804730
MN
Other
Enumeration date
11/29/2005
Last updated
01/10/2021
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