Individual
MIRANDA PAIGE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4 S 2600 W STE 6, HURRICANE, UT 84737-3247
(435) 229-8405
Mailing address
101 S MAIN ST, HURRICANE, UT 84737-2631
(318) 355-3099
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
12/22/2022
Last updated
12/22/2022
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