Individual
ADRIENNE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
300 BREEZE PARK DR., WELDON SPRINGS, MO 63304
(636) 720-3090
Mailing address
5072 DOUGLAS PARK DR, SAINT PETERS, MO 63304
(636) 720-3090
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2010010977
MO
Other
Enumeration date
07/29/2021
Last updated
07/29/2021
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