Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251H1300X | Human Factors | 010000508 | DC |
N | 225XH1300X | Human Factors | 010000508 | DC |
N | 2251H1300X | Human Factors | 0119004399 | VA |
N | 225XH1300X | Human Factors | 0119004399 | VA |
N | 2251H1300X | Human Factors | 220439 | OR |
N | 225XH1300X | Human Factors | 220439 | OR |
Y | 2251H1300X | Human Factors | 2758 | NM |
Y | 225XH1300X | Human Factors | 2758 | NM |
NPI | 1437455219 |
---|---|
Provider Name | Kristin Marie Wallace |
First Address | Arlington, VA 22204 |
Second Address | Arlington, VA 22204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2011 |
Last Update Date | 30/01/2019 |