Individual
LISA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
28748
SC
363LA2100X
Acute Care Nurse Practitioner
NP-14866
OH
Other
Enumeration date
08/01/2013
Last updated
09/13/2024
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