Individual
PATRICIA G WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNS
Contact information
Practice address
4847 E VIRGINIA ST STE D, EVANSVILLE, IN 47715-2611
(812) 479-1242
(812) 479-1330
Mailing address
4847 E VIRGINIA ST STE D, EVANSVILLE, IN 47715-2611
(812) 479-1242
(812) 479-1330
Taxonomy
Speciality
Code
Description
License number
State
364S00000X
Clinical Nurse Specialist
70000099A
IN
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
70000099B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000492046
ANTHEM
IN
Enumeration date
07/17/2006
Last updated
07/21/2022
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