Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
LAURY M WALLACE, NP
Active Sole ProprietorLAURY M WALLACE, NP is a Adolescent Medicine healthcare provider located in WESTFIELD, Indiana. NPI 1205343845 is currently active in the NPPES registry. Verify at CMS.
Adolescent Medicine · WESTFIELD, IN
Registration Details
- NPI Number
- 1205343845
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Jan 4, 2018 (8.6254247863295 yrs)
- Last Updated
- Jan 4, 2018
- Licenses
-
71007724A (IN)71007724A (IN)71007724A (IN)71007724A (IN)
- Sole Proprietor
- Yes
Practice Information
- Address
-
16731 GAITHER BLVDWESTFIELD, IN, 460744607Browse IN providers · Browse ZIP 46074
- Phone
- 3175616840
- Fax
- 8122393771
- Primary Specialty
-
Adolescent Medicine
207QA0505X
- Additional Specialty
- Geriatric Medicine
- Additional Specialty
- Hospice and Palliative Medicine
- Additional Specialty
- Adolescent Medicine
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.