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Individual

LISA FAYE WALLACE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
X

Contact information

Practice address
149 VASS RD, LINDSIDE, WV 24951
(304) 646-4526
Mailing address
PO BOX 175, LINDSIDE, WV 24951-0175

Taxonomy

Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary

Other

Enumeration date
07/16/2025
Last updated
07/16/2025
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