Individual
MISS CARRIE MARIE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
472 PIKE STREET, MARIETTA, OH 45750
(740) 236-4452
(740) 236-4453
Mailing address
472 PIKE STREET, MARIETTA, OH 45750
(740) 236-4452
(740) 236-4453
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
115406
OH
Other
Enumeration date
10/01/2021
Last updated
10/01/2021
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