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SUZANNE M. WALLACE R.N.
>> Registered Nurse >> Nursing Service ProvidersRegistrant NPI Number: 1710055090
Individual Registrant: SUZANNE M. WALLACE R.N.
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
7544 COUNTY ROAD P PRESQUE ISLE, WI 54557-9369 US
Tel: 715-686-7281 Fax: --
Tel: 715-686-7281 Fax: --
Contact information for business:
7544 COUNTY ROAD P PRESQUE ISLE, WI 54557-9369 US
Tel: 715-686-7281 Fax: --
Tel: 715-686-7281 Fax: --
Registration Information:
NPI: 1710055090
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 163W00000X | Nursing Service Providers Registered Nurse | WI |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 350 13900 | WI | 05 |
