Individual
WALLACE EUGENE RALSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2305 S 65 HIGHWAY, MARSHALL, MO 65340
(660) 886-3554
(660) 831-3308
Mailing address
2305 SOUTH 65 HIGHWAY, MARSHALL, MO 65340-2640
(660) 886-7431
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
2020034592
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
152532
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30004543120001
—
KS
05
—
918782004
—
MO
Enumeration date
05/18/2006
Last updated
04/03/2025
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