Individual
DANA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
13255 ROAD 22K, CLOVERDALE, OH 45827-9454
(419) 532-3747
Mailing address
13255 ROAD 22K, CLOVERDALE, OH 45827-9454
(419) 532-3747
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN278652
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
264014957703
—
OH
Enumeration date
05/24/2007
Last updated
07/08/2007
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