Individual
BRIANNA M WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1945 ROUTE 70 E STE D, CHERRY HILL, NJ 08003-2160
(856) 237-8045
(856) 237-8047
Mailing address
301 LIPPINCOTT DR STE 410, MARLTON, NJ 08053-4197
(856) 237-8045
(856) 237-8047
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00835000
NJ
363A00000X
Physician Assistant
C0009759
MD
363A00000X
Physician Assistant
C5-0012199
DE
Other
Enumeration date
01/24/2024
Last updated
05/08/2026
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