Individual
RACHEL RENEE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1311 N MILDRED RD, CORTEZ, CO 81321
(970) 555-6666
Mailing address
35505 ROAD K.1, MANCOS, CO 81328-8978
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C-APN.0001428-C-CRNA
CO
367500000X
Certified Registered Nurse Anesthetist
R0088890
OK
Other
Enumeration date
01/04/2013
Last updated
08/08/2022
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