Individual
CHIARA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
961 E CRANDALL AVE, SALT LAKE CITY, UT 84106-2107
(612) 770-9037
Mailing address
961 E CRANDALL AVE, SALT LAKE CITY, UT 84106-2107
(612) 770-9037
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
11624749-4405
UT
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
06/16/2022
Last updated
12/08/2024
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