Individual
MR. TIMOTHY THOMAS WALLACE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
10000 BRECKSVILLE RD, BRECKSVILLE, OH 44141-3204
(440) 526-3030
Mailing address
10000 BRECKSVILLE RD, BRECKSVILLE, OH 44141-3204
(440) 526-3030
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
RN295020
OH
Other
Enumeration date
08/05/2008
Last updated
08/05/2008
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