Vidette Marie Wallace LPN

NPI 1760712822 - Licensed Practical Nurse - 164W00000X

NPI Details
NPI 1760712822
Gender Female
Enumeration Date 01/12/2010
Last Updated 01/12/2010
Entity Type Individual
Active Over 6 years ago
Practice Location
7102 MIDDLEBROOK BLVD
MIDDLEBURG HTS OH, 44130, US
Phone (216) 265-0969
Fax
Business Location
7102 MIDDLEBROOK BLVD
MIDDLEBURG HTS OH, 44130, US
Phone (216) 265-0969
Fax
Toxanomy
Taxonomy Code 164W00000X
License State Ohio
License Number PN115195
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According to our database, Ms. Vidette Marie Wallace LPN NPI is 1760712822, taxonomy code is 164W00000X and license number is PN115195, license state is located at Ohio. Vidette Marie Wallace LPN physically located at 7102 Middlebrook Blvd, Middleburg Hts OH, 44130. NPI Number Vidette Marie Wallace LPN has the Individual type.

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1760712822 NPI number is provided on an as is basis without warranty of any kind. 1760712822 is maintained by the National Plan & Provider Enumeration System. The contents of Vidette Marie Wallace LPN are for informational purposes only.