Susan Jean Wallace
NPI #1194985887 in Pine Ridge, South Dakota
Provider Information
- NPI Number
- 1194985887
- Entity Type
- Individual
- Name
- Susan Jean Wallace
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Registered Nurse
- Enumeration Date
- Jun 16, 2008
- Last Updated
- Jun 16, 2008
Practice Location
- Address
- E HWY 18
- City
- Pine Ridge
- State
- South Dakota
- ZIP Code
- 57770-1201
- Phone
- (605) 867-5131
Specialties & Taxonomy Codes
| Specialty |
|---|
| Registered Nurse |
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