Individual
MRS. SARAH WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
390 LIMIT ST, LEAVENWORTH, KS 66048-4525
(913) 651-2323
Mailing address
18714 W 163RD TER, OLATHE, KS 66062-2786
(785) 249-4676
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
76650
KS
Other
Enumeration date
01/07/2015
Last updated
01/07/2015
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