Individual
LISA ANN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8700 MOSHERVILLE RD, HORTON, MI 49246-9601
(517) 358-5830
Mailing address
8700 MOSHERVILLE RD, HORTON, MI 49246-9601
(517) 358-5830
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703086959
MI
Other
Enumeration date
04/17/2019
Last updated
12/12/2023
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