Individual
COLLEEN ELIZABETH WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
600 S AIRPORT RD BLDG D, LONGMONT, CO 80503-6476
(303) 494-2705
Mailing address
600 S AIRPORT RD STE D, LONGMONT, CO 80503-6424
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0007479
CO
Other
Enumeration date
10/07/2022
Last updated
09/27/2023
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