Individual
LEIGH E. WALLACE IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
810 SAINT VINCENTS DR, BIRMINGHAM, AL 35205-1601
(205) 939-7143
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701
(205) 297-9411
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1-093252
AL
Other
Enumeration date
07/23/2012
Last updated
11/06/2017
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