Individual
CHERRY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
425 N NEW BALLAS RD STE 203, SAINT LOUIS, MO 63141-6848
(314) 872-3104
Mailing address
905 CHESTNUT RIDGE RD, MANCHESTER, MO 63021-6925
(314) 536-1897
(314) 536-1897
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
2025047590
MO
Other
Enumeration date
11/03/2025
Last updated
11/04/2025
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