Individual
DR. DANIELLE CHARISSE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
4301088447
MI
208000000X
Pediatrics Physician
8023169-1205
UT
208000000X
Pediatrics Physician
MD61340360
WA
208000000X
Pediatrics Physician
Primary
ME129213
FL
208000000X
Pediatrics Physician
U0741
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2231891
—
WA
Enumeration date
04/26/2007
Last updated
06/13/2023
Update your record
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