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Individual

KIMBERLY ANN WALLACH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NNP-BC

Contact information

Practice address
4710 MONTGOMERY BLVD NE, ALBUQUERQUE, NM 87109-1220
(806) 470-8876
Mailing address
3423 68TH DR, LUBBOCK, TX 79413-6121
(806) 470-8876

Taxonomy

Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
AP144855
TX

Other

Enumeration date
09/30/2020
Last updated
09/30/2020
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