Individual
MRS. LAURA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
710 N MAIN ST, CLINTON, TN 37716-3143
(865) 425-8800
Mailing address
124 DONNA LN, JACKSBORO, TN 37757-2729
(423) 579-4539
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
275332
TN
Other
Enumeration date
10/07/2024
Last updated
10/07/2024
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