Individual
DR. JENNA ROSE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, APRN, CNP
Contact information
Practice address
1220 SHEYENNE ST, WEST FARGO, ND 58078-2637
(701) 234-4445
(701) 234-4456
Mailing address
3122 46TH AVE S, FARGO, ND 58104-6658
(701) 520-1852
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R37792
ND
Other
Enumeration date
07/05/2017
Last updated
07/05/2017
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