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Individual

ALYSSA ANN WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
4103 S YALE AVE STE B, TULSA, OK 74135-6002
(918) 382-7300
(918) 392-3471
Mailing address
PO BOX 700360, TULSA, OK 74170-0360
(918) 382-7300
(918) 392-3471

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary

Other

Enumeration date
10/06/2022
Last updated
10/06/2022
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