Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 2020012757 | MO |
NPI | 1902428071 |
---|---|
Provider Name | Kali Wallace |
First Address | Independence, MO 64057-3328 |
Second Address | Lees Summit, MO 64063-2277 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2020 |
Last Update Date | 12/05/2020 |