Individual
MRS. BARBARA JEAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
707 ROE AVE, ELMIRA, NY 14905-1642
(607) 732-6992
Mailing address
1008 HALL ST, ELMIRA, NY 14901-1522
(607) 734-8513
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
237963-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02680899
PROVIDER NUMBER
NY
Enumeration date
06/18/2007
Last updated
07/08/2007
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