Individual
JACQUE WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1217 RIVERSIDE AVE, FORT COLLINS, CO 80524-3218
(970) 494-4200
Mailing address
4856 INNOVATION DR STE B, FORT COLLINS, CO 80525-5540
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
88881
CO
Other
Enumeration date
04/16/2020
Last updated
04/16/2020
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