Individual
LAUREL E WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
50 PLEASANT ST, NORTHAMPTON, MA 01060-4127
(413) 584-6855
Mailing address
15 LAURA DRIVE, WESTFIELD, MA 01085
(413) 562-2747
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
RN121600
MA
Other
Enumeration date
02/06/2019
Last updated
11/26/2019
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