Individual
TANESIA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5333 BLOSSOM ST APT 312, WEST CHESTER, OH 45011-8775
(513) 236-7764
Mailing address
870 SOUTHMEADOW CIR UNIT 102, CINCINNATI, OH 45231-6116
(513) 236-7764
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
323801911210
OH
Other
Enumeration date
02/27/2023
Last updated
07/09/2023
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