Individual
MELISSA S WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
151 W 7TH AVE STE 163, EUGENE, OR 97401-2676
(541) 682-4464
Mailing address
2420 POLK ST, EUGENE, OR 97405-1837
(541) 650-2236
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201393584LPN
OR
Other
Enumeration date
01/31/2019
Last updated
01/31/2019
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