Kyle Edwin Wallace

NPI #1619781408 in Blair, Nebraska

Provider Information

NPI Number: 1619781408
Entity Type: Individual
Name: Kyle Edwin Wallace
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Adult Companion
Enumeration Date: Feb 3, 2025
Last Updated: Feb 13, 2025

Practice Location

Address: 1927 LINCOLN ST
City: Blair
State: Nebraska
ZIP Code: 68008-1934
Phone: (531) 209-6113

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Adult Companion	372600000X	Primary

Additional Practice Locations

10737 Brentwood Dr Apt 2B

La Vista, NE, 68128-4737

(531) 209-6113

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