Individual
KAY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
601 HAMILTON AVE, TRENTON, NJ 08629-1915
(609) 599-5097
(609) 599-6312
Mailing address
PO BOX 18736, NEWARK, NJ 07191-8736
(800) 426-1699
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
26NR03239800
NJ
Other
Enumeration date
07/21/2006
Last updated
07/08/2007
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