Individual
LATRICE SHEMON WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
7009 N 43RD ST # 7A, MILWAUKEE, WI 53209-2263
(414) 574-8984
Mailing address
7009 N 43RD ST # 7A, MILWAUKEE, WI 53209-2263
(414) 574-8984
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
257195
WI
Other
Enumeration date
01/16/2021
Last updated
01/16/2021
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