Individual
RAEDELLE JEANE LAWRENCE - WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
401 W POPLAR ST, CARDIOLOGY SUITE, WALLA WALLA, WA 99362-2846
(509) 522-5731
Mailing address
122 W 7TH AVE STE 310, SPOKANE, WA 99204-2352
(509) 838-7711
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP30003980
WA
Other
Enumeration date
07/08/2010
Last updated
07/08/2010
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