Individual
DOMINIQUE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3739 N 38TH ST, MILWAUKEE, WI 53216-3011
(262) 672-3139
(262) 672-3139
Mailing address
3739 N 38TH ST, MILWAUKEE, WI 53216-3011
(262) 672-3139
(262) 672-3139
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
W4201789495600
WI
Other
Enumeration date
07/18/2025
Last updated
07/18/2025
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