Individual
ROSE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
241 GREENHOUSE RD, LEXINGTON, VA 24450-3717
(540) 463-3141
(540) 462-6701
Mailing address
241 GREENHOUSE RD, LEXINGTON, VA 24450-3717
(540) 463-3141
(540) 462-6701
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0002019354
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649377912
—
VA
Enumeration date
11/22/2013
Last updated
11/22/2013
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