Individual
CLEOPATRA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
777 HEMLOCK ST, MACON, GA 31201-2102
(478) 633-2147
(478) 742-9670
Mailing address
PO BOX 551420, FORT LAUDERDALE, FL 33355-1420
(800) 243-3839
(855) 851-4405
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN181636
GA
367500000X
Certified Registered Nurse Anesthetist
Primary
RN181636
GA
Other
Enumeration date
08/10/2015
Last updated
03/12/2018
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