Individual
JOSHUA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
43335 KALIFORNSKY BEACH RD STE 36, SOLDOTNA, AK 99669-8280
(907) 262-6331
(907) 260-4892
Mailing address
43335 KALIFORNSKY BEACH RD STE 36, SOLDOTNA, AK 99669-8280
(907) 262-6331
(907) 260-4892
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CMG675
—
AK
Enumeration date
03/11/2011
Last updated
03/11/2011
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