Individual
SEAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
167 NORTH MAIN STREET, TUBA CITY, AZ 86045-0600
(928) 283-2501
(928) 283-2677
Mailing address
PO BOX 600, PFS BUSINESS OFFICE, TUBA CITY, AZ 86045-0600
(928) 283-2781
(928) 283-2677
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
CNA1000037427
AZ
Other
Enumeration date
10/13/2014
Last updated
10/13/2014
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