Patti Wallace

NPI #1033435250 in Jonesboro, Arkansas

Provider Information

NPI Number: 1033435250
Entity Type: Individual
Name: Patti Wallace
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Specialist
Enumeration Date: Apr 13, 2010
Last Updated: Apr 13, 2010

Practice Location

Address: 806 GLENDALE ST
City: Jonesboro
State: Arkansas
ZIP Code: 72401-4455
Phone: (870) 933-9528

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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