Individual
HEATHER WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16615 130TH AVE, RODNEY, MI 49342-9707
(517) 213-1341
Mailing address
16615 130TH AVE, RODNEY, MI 49342-9707
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703103229
MI
Other
Enumeration date
12/19/2018
Last updated
12/19/2018
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