Individual
MS. KIMBERLY ANN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1800 N CAPITOL AVE, E416, INDIANAPOLIS, IN 46202-1218
(317) 962-0097
Mailing address
1800 NORTH CAPITOL AVENUE, E416, INDIANAPOLIS, IN 46202
(317) 962-0097
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
28178607A
IN
Other
Enumeration date
11/20/2012
Last updated
11/20/2012
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