Individual
DANTORIA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
157 BROZZINI CT, GREENVILLE, SC 29615-5340
(800) 805-6989
Mailing address
157 BROZZINI CT, GREENVILLE, SC 29615-5340
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
54228
SC
Other
Enumeration date
04/30/2024
Last updated
04/30/2024
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