Individual
MS. JUDITH MARY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RXN,NP
Contact information
Practice address
100 HEALTH PARK DR, LOUISVILLE, CO 80027-9583
(303) 673-1102
Mailing address
31371 LOGES LN, EVERGREEN, CO 80439-9460
(303) 674-7603
Taxonomy
Speciality
Code
Description
License number
State
363LN0005X
Critical Care Neonatal Nurse Practitioner
Primary
96216
CO
Other
Enumeration date
05/06/2007
Last updated
07/08/2007
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