Individual
KECHA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
885 ROBIN DR, SUN PRAIRIE, WI 53590-3319
(608) 234-0265
Mailing address
885 ROBIN DR, SUN PRAIRIE, WI 53590-3319
(608) 234-0265
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
229385-30
WI
Other
Enumeration date
03/12/2019
Last updated
03/12/2019
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