Individual
BRIDGET RENA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2626 W COLLEGE RD, SPRINGFIELD, MO 65802-4637
(417) 869-8086
Mailing address
1601 OLD SOUTH RIVER RD, SAINT CHARLES, MO 63303-4120
(636) 224-1210
(636) 246-1008
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2006004371
MO
Other
Enumeration date
08/12/2022
Last updated
08/12/2022
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