Organization
EDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE L WALLACE (REGISTERED NURSE)
(608) 205-9974
Entity
Organization
Contact information
Practice address
1202 N PAGE ST, STOUGHTON, WI 53589-1161
(608) 205-9974
Mailing address
1202 N PAGE ST, STOUGHTON, WI 53589-1161
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
—
WI
Other
Enumeration date
05/11/2006
Last updated
08/22/2020
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