Individual
MRS. AMY BETH WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
150 GATE HOUSE TRL, HENRIETTA, NY 14467-9559
(585) 359-3557
Mailing address
150 GATE HOUSE TRL, HENRIETTA, NY 14467-9559
(585) 359-3557
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
276860
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02570267
—
NY
Enumeration date
03/14/2008
Last updated
03/14/2008
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