Individual
ANGELA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, SANE
Contact information
Practice address
3020 OLD BOONESBORO RD, WINCHESTER, KY 40391-9207
(859) 779-8291
Mailing address
3020 OLD BOONESBORO RD, WINCHESTER, KY 40391-9207
(859) 779-8291
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
1096760
KY
Other
Enumeration date
12/05/2024
Last updated
12/05/2024
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