Individual
ROBIN PATRICIA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.M., LIC. AC.
Contact information
Practice address
146 GLORY LANE, GLORIETA, NM 87535
(505) 231-6684
(505) 884-4015
Mailing address
PO BOX 422, GLORIETA, NM 87535
(505) 231-6684
(505) 884-4015
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
AK000355L
PA
171100000X
Acupuncturist
Primary
KO000048L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1824619
HIGHMARK BS-PREM
PA
Enumeration date
09/03/2006
Last updated
03/02/2009
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