Individual
JOEL NIELSON WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RNFA
Contact information
Practice address
9354 PUMICE LN, CENTRAL POINT, OR 97502-9325
(541) 826-7209
(541) 779-4824
Mailing address
9354 PUMICE LN, CENTRAL POINT, OR 97502-9325
(541) 826-7209
(541) 779-4824
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
086006227RN
OR
Other
Enumeration date
10/31/2008
Last updated
10/31/2008
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