Individual
ELIZABETH LEE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5165 MCCARTY LN, LAFAYETTE, IN 47905, LAFAYETTE, IN 47905
(765) 730-5662
Mailing address
3001 BURTON RD, WESTPOINT, IN 47992-9339
(765) 730-5662
(765) 730-5662
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
28263926A
IN
Other
Enumeration date
03/11/2025
Last updated
03/11/2025
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