Individual
ROBERT WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
367 HOSPITAL BLVD, JACKSON, TN 38305-2080
(731) 661-2227
Mailing address
367 HOSPITAL BLVD, JACKSON, TN 38305-2080
(731) 661-2227
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
53447
TN
Other
Enumeration date
02/19/2007
Last updated
11/04/2011
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