Individual
NICOLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
70 E 91ST ST STE 109, INDIANAPOLIS, IN 46240-1550
(419) 695-8010
(419) 932-6232
Mailing address
10100 ELIDA RD, DELPHOS, OH 45833-9058
(419) 695-8010
(419) 932-6232
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
IN
Other
Enumeration date
09/23/2020
Last updated
10/01/2025
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