Wallace, Mindy Lee

Wallace, Mindy Lee is an individual health care provider with primary practice located at 935 Jersey St , Quincy IL 62301-4030. She recently has only one registered license in Dietary & Nutritional Service Providers / Dietitian, Registered, which is considered as her primary health care specialty. Wallace, Mindy Lee can be contacted via phone (217) 228-2413.

Contact Information

Primary practice address
935 Jersey St Quincy IL 62301-4030
Phone: (217) 228-2413
Fax: (217) 228-2416
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dietary & Nutritional Service Providers / Dietitian, Registered 133V00000X 164003636 Illinois
Dietary & Nutritional Service Providers / Dietitian, Registered 133V00000X 2005004105 Missouri

Profile Details

NPI number 1851305304
LBN Legal business name Wallace, Mindy Lee
Credentials RD LDN
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 28th, 2006
Last updated Sep 22nd, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1851305304 NPPES
Illinois Other 00132009 BLUE CROSS BLUE SHIELD IL
Illinois Other 075113 BLUE CROSS BLUE SHIELD IL

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