Individual
MS. LORI LYNNE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN, RCS
Contact information
Practice address
1009 N HEMLOCK ST, IRONWOOD, MI 49938-1022
(906) 364-4247
Mailing address
1009 N HEMLOCK ST, IRONWOOD, MI 49938-1022
(906) 364-4247
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
309826031
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35061000
—
WI
Enumeration date
10/08/2008
Last updated
10/08/2008
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