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Individual

ADAM K WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
600 HIGHLAND AVE, MADISON, WI 53792-1528
(608) 263-8100
Mailing address
616 19TH ST, COLUMBUS, GA 31901-1528
(706) 494-4262

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
1-083374
AL
367500000X
Certified Registered Nurse Anesthetist
Primary
209183
WI

Other

Enumeration date
06/14/2010
Last updated
02/05/2025
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