Jessica Wallace

NPI #1184820565 in Boulder, Colorado

Provider Information

NPI Number: 1184820565
Entity Type: Individual
Name: Jessica Wallace
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Registered Nurse
Enumeration Date: Jun 22, 2007
Last Updated: May 2, 2008

Practice Location

Address: 580 MOHAWK DR
City: Boulder
State: Colorado
ZIP Code: 80303-3712
Phone: (303) 554-5185

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Licensed Practical Nurse	164W00000X
Registered Nurse	163W00000X	Primary

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