Individual
JESSICA R WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
953 S SOUTH ST, WILMINGTON, OH 45177-2921
(937) 383-4441
Mailing address
5106 BARKER RD, FAYETTEVILLE, OH 45118-9717
(740) 851-2022
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN.503064
OH
Other
Enumeration date
04/30/2024
Last updated
05/03/2024
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