Individual
DAWN L. WALLACE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
18595 BROOKRIDGE DR, BROOKFIELD, WI 53045-1026
(262) 894-3880
(262) 754-0690
Mailing address
18595 BROOKRIDGE DR, BROOKFIELD, WI 53045-1026
(262) 894-3880
(262) 754-0690
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38214700
—
WI
Enumeration date
05/09/2006
Last updated
07/08/2007
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