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Lawanda Wallace
NPI 1154788875 · on the registry since 2016 · sole proprietor
Practice
- Address
- 11559 S Oakley Ave
Chicago, IL 60643 - Phone
- (773) 391-6689
Registry record
- Primary taxonomy
- 347C00000X
347C00000X
- Licence states on file
- IL
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2016-01-26
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois