Individual
KIMBERLY D. WALLACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
551 BROADWAY, EAGLE, CO 81631
(970) 328-8840
(970) 328-8829
Mailing address
P.O BOX 660, EAGLE, CO 81631-0660
(970) 328-8840
(970) 328-8829
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
168056
MI
Other
Enumeration date
04/09/2009
Last updated
04/09/2009
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