Individual
FELICIA MARIE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
16001 WEST 9 MILE ROAD, SOUTHFIELD, MI 48075
(248) 849-2528
Mailing address
16001 WEST 9 MILE ROAD, PROVIDENCE HOSPITAL, SOUTHFIELD, MI 48075
(248) 849-2528
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704238067
MI
Other
Enumeration date
01/18/2012
Last updated
02/27/2014
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