Individual
MISS EVELYN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
2204 E DEBORAH LN, ORANGE, CA 92869-4620
(714) 336-3712
Mailing address
2906 E HOOVER AVE, ORANGE, CA 92867-6253
(714) 639-1465
Taxonomy
Speciality
Code
Description
License number
State
376G00000X
Nursing Home Administrator
Primary
300613124
CA
Other
Enumeration date
07/16/2021
Last updated
07/16/2021
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