Individual
LAURA ANN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.P.N
Contact information
Practice address
301 N HIGHWAY 21, PILOT KNOB, MO 63663-7862
(573) 546-8036
(573) 546-8067
Mailing address
301 N HIGHWAY 21, PILOT KNOB, MO 63663-7862
(573) 546-8036
(573) 546-8067
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
2010037004
MO
Other
Enumeration date
01/14/2011
Last updated
08/07/2025
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