Individual
JAMIE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
559 W GERMANTOWN PIKE, EAST NORRITON, PA 19403-4250
(484) 622-1248
(484) 622-1269
Mailing address
101 E OLNEY AVE STE 400, PHILADELPHIA, PA 19120-2470
(215) 456-1825
(215) 456-5926
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
RN676582
PA
367500000X
Certified Registered Nurse Anesthetist
Primary
RN676582
PA
Other
Enumeration date
10/24/2023
Last updated
06/11/2025
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