Individual
MAUREEN MARY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2500 E HUNT DR STE H-J, SHOW LOW, AZ 85901-7954
(928) 537-6937
(928) 537-3977
Mailing address
2500 E HUNT DR STE H-J, SHOW LOW, AZ 85901-7954
(928) 537-6937
(928) 537-3977
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
3191
AZ
Other
Enumeration date
06/22/2006
Last updated
06/14/2023
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