Individual
JANELL MAE LORTON WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1000 E 1ST ST STE 404, DULUTH, MN 55805-2297
(218) 722-5513
Mailing address
1000 E 1ST ST, STE 404, DULUTH, MN 55805-2297
(952) 913-9930
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
13693
MN
363AS0400X
Surgical Physician Assistant
Primary
13693
MN
Other
Enumeration date
08/09/2020
Last updated
07/17/2024
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