Individual
PAUL S WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
513 SE QUAPAW, BARTLESVILLE, OK 74003
(918) 337-8080
(918) 337-8099
Mailing address
1400 S HIGH STREET, CANEY, KS 67333
(918) 337-8080
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L0050977
OK
Other
Enumeration date
12/28/2007
Last updated
12/28/2007
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