Individual
LAUREN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4190 LOBERG AVE, DULUTH, MN 55811-2652
(218) 249-4600
Mailing address
4190 LOBERG AVE, DULUTH, MN 55811-2652
(218) 249-4600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
125065769
IL
207Q00000X
Family Medicine Physician
2021034580
MO
207Q00000X
Family Medicine Physician
Primary
73123
MN
Other
Enumeration date
07/09/2014
Last updated
01/30/2023
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