Individual
CATHERINE D WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
8495 CRATER LAKE HWY, WHITE CITY, OR 97503-3011
(541) 826-2111
Mailing address
403 MACE RD, MEDFORD, OR 97501-1233
(541) 292-4552
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
202005542RN
OR
Other
Enumeration date
05/11/2022
Last updated
05/11/2022
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