Individual
MS. KENDA JOLEEN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4212 NORTH 16TH ST,, PHOENIX, AZ 85016
(602) 263-1511
(602) 263-1619
Mailing address
PO BOX 31001-0698, PASADENA, CA 91110-0698
(602) 263-1511
(602) 263-1619
Taxonomy
Speciality
Code
Description
License number
State
163WI0600X
Infection Control Registered Nurse
Primary
E42490
CT
Other
Enumeration date
12/11/2006
Last updated
07/08/2007
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