Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath |
NPI | 1124395603 |
---|---|
Provider Name | Mrs. Katherine J Wallace |
First Address | Madison, WI 53703-2637 |
Second Address | Madison, WI 53703-2637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2011 |
Last Update Date | 28/11/2011 |