Individual
MS. SUZANNE BETH WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN,BC
Contact information
Practice address
2500 OVERLOOK TER, MADISON, WI 53705-2254
(608) 256-1901
Mailing address
1826 VAN HISE AVE, MADISON, WI 53726-4053
(608) 236-9071
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
3054-033
WI
Other
Enumeration date
04/03/2007
Last updated
07/08/2007
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