Individual
JENNIFER M WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3640 MAIN ST, SUITE 302, SPRINGFIELD, MA 01107-1145
(413) 732-4242
(413) 732-4040
Mailing address
3640 MAIN ST, SUITE 302, SPRINGFIELD, MA 01107-1145
(413) 732-4242
(413) 732-4040
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN218174
MA
Other
Enumeration date
03/05/2009
Last updated
04/21/2016
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