Individual
SHARANDELL RENA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
605 SW US HIGHWAY 40 # 146, BLUE SPRINGS, MO 64014-3232
(816) 479-1426
Mailing address
605 SW US HIGHWAY 40 # 146, BLUE SPRINGS, MO 64014-3232
(816) 479-1426
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2015022803
MO
Other
Enumeration date
03/18/2026
Last updated
03/18/2026
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