Individual
CRAWFORD REED WALLACE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
32 CLEAR SKY DR, CARRIERE, MS 39426-7818
(601) 337-0700
Mailing address
32 CLEAR SKY DR, CARRIERE, MS 39426-7818
(601) 337-0700
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R881469
MS
367500000X
Certified Registered Nurse Anesthetist
Primary
R881469
MS
Other
Enumeration date
04/17/2013
Last updated
02/22/2016
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