Individual
LISA CATHERINE SIMS WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
421 WEST COLLEGE ST, INFANTS AND CHILDRENS CLINIC PC, FLORENCE, AL 35630
(256) 764-9522
(256) 764-1139
Mailing address
421 WEST COLLEGE ST, FLORENCE, AL 35630
(256) 764-9522
(256) 764-1139
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
1756561
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51030973
BC
AL
Enumeration date
08/10/2006
Last updated
07/08/2007
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