Individual
JESSICA A. WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, PMHNP
Contact information
Practice address
903 MINERAL POINT AVE, JANESVILLE, WI 53548-2970
(608) 756-5555
(608) 756-0174
Mailing address
903 MINERAL POINT AVE, JANESVILLE, WI 53548-2970
(608) 756-5555
(608) 756-0174
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
179176-130
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
9344-33
WI
Other
Enumeration date
07/09/2019
Last updated
07/09/2019
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