Individual
GISELLE TISHA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
5809 W RICE, CHGO, IL 60651
(773) 573-5347
Mailing address
5809 W RICE, CHICAGO, IL 60651
(773) 573-5347
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
—
IL
Other
Enumeration date
09/19/2016
Last updated
09/19/2016
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