Individual
MS. GLORIA ELIZABEETH WALLACE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
141 MACON ST, BROOKLYN, NY 11216-2206
(718) 230-9734
(718) 230-9734
Mailing address
141 MACON ST, RM 127, BROOKLYN, NY 11216-2206
(718) 230-9734
(718) 230-9734
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
468506
NY
Other
Enumeration date
03/23/2012
Last updated
03/23/2012
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