Individual provider · Type 1 NPI
Lisa Lynn Wallace, RN
Neonatal Intensive Care Registered Nurse · Jacksonville, FL
NPI number
1396403135
Active
Practice location
800 Prudential Dr
Jacksonville, FL 32207-8211
Mailing address
546 Rocky Creek Rd
Hampton, GA 30228-3071
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Neonatal Intensive Care Registered Nurse Primary | 163WN0002X | RN089537 (GA) |
Neonatal Intensive Care Registered Nurse: Definition to come...
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About NPI 1396403135
Lisa Lynn Wallace, RN's National Provider Identifier is 1396403135, issued on Nov 29, 2021. The primary taxonomy on file is Neonatal Intensive Care Registered Nurse (163WN0002X), and the practice location is in Jacksonville, FL. The record was last updated on Nov 29, 2021.