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Individual

CATHERINE WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
12339 STRATFORD DR, CLIVE, IA 50325-8148
(515) 263-9107
(515) 265-9888
Mailing address
12339 STRATFORD DR, CLIVE, IA 50325-8148
(515) 263-9107
(515) 265-9888

Taxonomy

Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
A106126
IA
363LP1700X
Perinatal Nurse Practitioner
A106126
IA
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
A106126
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1033200431
IA
01
IA0104
JOHN DEERE
IA
Enumeration date
09/28/2006
Last updated
07/28/2025
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