Individual
JESSICA LYNN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
65 CAMBRIAN WAY APT 110, BURLINGTON, VT 05401-2970
(802) 503-8051
Mailing address
65 CAMBRIAN WAY APT 110, BURLINGTON, VT 05401-2970
(802) 503-8051
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
025.0112709
VT
Other
Enumeration date
11/05/2021
Last updated
11/05/2021
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