Individual
MARIAH WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
508 S CHURCH ST, MT PLEASANT, PA 15666-1702
(724) 547-7092
(724) 547-7096
Mailing address
508 S CHURCH ST, MT PLEASANT, PA 15666-1702
(724) 547-7092
(724) 547-7096
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA067651
PA
363AM0700X
Medical Physician Assistant
Primary
C0009066
MD
363AM0700X
Medical Physician Assistant
Primary
MA067651
PA
Other
Enumeration date
09/18/2023
Last updated
05/15/2026
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