Individual
TRENTON WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2105 TITAN SPRINGS DR, PAPILLION, NE 68133-3421
(478) 294-0229
Mailing address
PO BOX 12362, OMAHA, NE 68112-0362
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
NE
Other
Enumeration date
09/25/2025
Last updated
09/25/2025
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