Individual
MISS CARRIE LEIGH WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
455 S MAIN ST, ORANGE, CA 92868-3835
(714) 289-4934
Mailing address
19001 FAIRHAVEN EXT, SANTA ANA, CA 92705-1359
(714) 633-8187
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
13730
CA
Other
Enumeration date
05/15/2007
Last updated
07/08/2007
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