NPI 1154788875

Lawanda Wallace

Practitioner Private Vehicle Chicago, IL

Practice location

Address: 11559 S Oakley Ave, Chicago, IL 60643-4721
Phone: (773) 391-6689

Registered specialties

Private Vehicle Primary

Transportation Services Taxonomy 347C00000X Licence W42053371706 (IL)

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Registry record

NPI: 1154788875
Entity type: Individual
Sex (as registered): Female
NPI issued: 26 Jan 2016
Record last updated: 26 Jan 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.