NPI 1568821874

Raymond Wallace, LPN

Practitioner Licensed Vocational Nurse Mandeville, LA

Practice location

Address: 23861 South Robin Rd, Mandeville, LA 70448
Phone: (985) 624-4100
Mailing address: PO Box 37, Mandeville, LA 70470-0037

Registered specialties

Licensed Vocational Nurse Primary

Nursing Service Providers Taxonomy 164X00000X Licence 20101002 (LA)

Other Licensed Vocational Nurse providers in Louisiana →

Registry record

NPI: 1568821874
Entity type: Individual
Sex (as registered): Male
NPI issued: 15 Feb 2016
Record last updated: 15 Feb 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.