Individual
MICHELE R WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
7770 MARSH RD, COTTRELLVILLE, MI 48039-3210
(586) 339-7930
Mailing address
7770 MARSH RD, COTTRELLVILLE, MI 48039-3210
(586) 339-7930
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
MI000061844
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MI000061844
CNA CERTIFICATION NUMBER
MI
Enumeration date
07/28/2021
Last updated
07/28/2021
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