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MRS. NYRISS AUDREY WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
550 OSBORNE RD NE, FRIDLEY, MN 55432-2718
(763) 236-5000
Mailing address
550 OSBORNE RD NE, FRIDLEY, MN 55432-2718
(763) 236-5000

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
104351
MN

Other

Enumeration date
06/25/2013
Last updated
06/25/2013
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