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Individual

ELIZABETH A WALLACE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
125 N COLLISON AVE, CIMARRON, NM 87714-8505
(575) 377-6991
(575) 376-2442
Mailing address
125 N COLLISON AVE, CIMARRON, NM 87714-8505
(575) 770-1700
(575) 376-2442

Taxonomy

Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
402513
NM

Other

Enumeration date
02/25/2021
Last updated
02/25/2021
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