MEDICARE: LORRIE KAY WALLACE ARNP, LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP30001964	WA
2	171100000X	Acupuncturist	AC60134530	WA

General Provider Information

NPI Number	:	1043305444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORRIE KAY WALLACE ARNP, LAC

Provider Business Mailing Address
First Line	:	PO BOX 31927
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-0027
Country	:	US
Telephone Number	:	206-436-9772
Fax Number	:

Provider Business Practice Location Address
First Line	:	2319 N 45TH ST
Second Line	:	SUITE #201
City	:	SEATTLE
State	:	WA
Zip	:	98103-6982
Country	:	US
Telephone Number	:	206-436-9772
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	12/11/2015

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