Lisa Wallace RN

NPI 1720476641 - Registered Nurse - 163W00000X

NPI Details
NPI 1720476641
Gender Female
Enumeration Date 12/30/2014
Last Updated 12/30/2014
Entity Type Individual
Active Over 1 year ago
Practice Location
935B SPRING ST
PLACERVILLE CA, 95667-4523, US
Phone (530) 621-6210
Fax
Business Location
3274 CARLSON DR
SHINGLE SPRINGS CA, 95682-8717, US
Phone
Fax
Toxanomy
Taxonomy Code 163W00000X
License State California
License Number 821591
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According to our database, Lisa Wallace RN NPI is 1720476641, taxonomy code is 163W00000X and license number is 821591, license state is located at California. Lisa Wallace RN physically located at 935b Spring St, Placerville CA, 95667-4523. NPI Number Lisa Wallace RN has the Individual type.

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1720476641 NPI number is provided on an as is basis without warranty of any kind. 1720476641 is maintained by the National Plan & Provider Enumeration System. The contents of Lisa Wallace RN are for informational purposes only.