Individual
MARLENE M.B. WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
5955 ZEAMER AVE, 673RD MEDICAL GROUP/SGHQ DOD-VA JOINT VENTURE HOSPITAL, JBER, AK 99506-3702
(907) 580-1035
(907) 580-3203
Mailing address
5955 ZEAMER AVE, 673RD MEDICAL GROUP/SGHQ DOD-VA JOINT VENTURE HOSPITAL, JBER, AK 99506-3702
(907) 580-1035
(907) 580-3203
Taxonomy
Speciality
Code
Description
License number
State
163WP0000X
Pain Management Registered Nurse
041305554
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209012095
IL
Other
Enumeration date
03/20/2006
Last updated
02/13/2023
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