Individual
MRS. MELISSA B WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP
Contact information
Practice address
111 SAINT LUKES CENTER DR STE 44B, CHESTERFIELD, MO 63017-3509
(143) 576-2424
(314) 576-2381
Mailing address
111 SAINT LUKES CENTER DR STE 44B, CHESTERFIELD, MO 63017-3509
(143) 576-2424
(314) 576-2381
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
151045
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
IL
Enumeration date
02/08/2012
Last updated
02/17/2025
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