Individual
CHRISTINE ELAINE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2160 HIGHWAY 2565, LOUISA, KY 41230-9166
(410) 463-3865
Mailing address
2160 HIGHWAY 2565, LOUISA, KY 41230-9166
(410) 463-3865
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
115096
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115096
OHIO BOARD OF NURSING
OH
Enumeration date
11/09/2012
Last updated
11/09/2012
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