Individual
LISA LYNN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
800 PRUDENTIAL DR, JACKSONVILLE, FL 32207-8211
(904) 202-8000
Mailing address
546 ROCKY CREEK RD, HAMPTON, GA 30228-3071
(678) 414-7809
Taxonomy
Speciality
Code
Description
License number
State
163WN0002X
Neonatal Intensive Care Registered Nurse
Primary
RN089537
GA
Other
Enumeration date
11/29/2021
Last updated
11/29/2021
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