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Individual

RICHARD WALLACE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
RN BSN

Contact information

Practice address
4905 HACKAMORE DR N, COLORADO SPRINGS, CO 80918-2632
(719) 252-6631
Mailing address
4905 HACKAMORE DR N, COLORADO SPRINGS, CO 80918-2632
(719) 252-6631

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
112239
CO

Other

Enumeration date
01/20/2017
Last updated
01/20/2017
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