Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | R3883 | KY |
NPI | 1306229620 |
---|---|
Provider Name | Dr. Chelsea Cernosek Wallace |
First Address | Lexington, KY 40536-0293 |
Second Address | Lexington, KY 40536-0293 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2015 |
Last Update Date | 30/06/2016 |