Individual
TEREASA ANNE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MN
Contact information
Practice address
1333 IRIS AVE, BOULDER, CO 80304-2226
(303) 443-8500
(720) 406-3664
Mailing address
1333 IRIS AVE, BOULDER, CO 80304-2226
(720) 562-0566
(720) 406-3664
Taxonomy
Speciality
Code
Description
License number
State
163WM0102X
Maternal Newborn Registered Nurse
Primary
92415
CO
Other
Enumeration date
04/06/2011
Last updated
04/06/2011
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