Individual
BIANCA NICHOLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
31 E CENTER ST STE 205, FAYETTEVILLE, AR 72701-5385
(479) 388-1513
Mailing address
31 E CENTER ST STE 205, FAYETTEVILLE, AR 72701-5385
(479) 388-1513
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
9289
AR
374J00000X
Doula
—
—
Other
Enumeration date
08/02/2024
Last updated
08/02/2024
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