Individual
SHANNON WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
201 S ASH ST, BUFFALO, MO 65622-8674
(417) 325-6000
Mailing address
21350 COUNTY ROAD 401, URBANA, MO 65767-8576
(620) 288-0416
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2025020699
MO
Other
Enumeration date
06/09/2025
Last updated
06/09/2025
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