IndividualActive
Angela Wallace, LPN
NPI 1306431101 · Licensed Practical Nurse · Greeneville, TN
Provider details
- NPI number
- 1306431101
- Entity type
- Individual
- Primary specialty
- Licensed Practical NurseNursing Service Providers
- Credential
- LPN
- Sex
- Female
- Sole proprietor
- No
- License
- 61990 (TN)
Specialties & taxonomies
Nursing Service Providers
Practice location
401 Holston Dr
Greeneville, TN 37743-3127
Phone: (423) 639-1104
Fax: (423) 467-3644
Approximate (ZIP-level) locationGet directions
Mailing address
1167 Spratlin Park Dr
Gray, TN 37615-6205
Registry dates
- Enumerated
- 2021-03-03
- Last updated
- 2021-03-03
- Certified
- 2021-03-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.