Individual
JESSICA FAYE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3020 14TH ST NW, WASHINGTON, DC 20009-6865
(202) 745-4300
(202) 745-2510
Mailing address
3020 14TH ST NW, WASHINGTON, DC 20009-6865
(202) 745-4300
(202) 745-2510
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0010-00640
NC
Other
Enumeration date
10/24/2006
Last updated
03/26/2021
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