Individual
EMILY B WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
400 PALMETTO HEALTH PKWY, COLUMBIA, SC 29212-1760
(800) 907-7000
Mailing address
209 TILLMAN ST, LEXINGTON, SC 29072-7536
(704) 245-2890
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
0001246344
VA
367500000X
Certified Registered Nurse Anesthetist
100969
SC
367500000X
Certified Registered Nurse Anesthetist
Primary
24736
TN
Other
Enumeration date
07/25/2013
Last updated
09/18/2018
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