Individual
MRS. ELLEE L WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2025 FRONTIS PLAZA BLVD., SUITE 120 FORSYTH COMPREHENSIVE NEUROLOGY, WINSTON-SALEM, NC 27103
(336) 277-2200
(336) 277-2210
Mailing address
2025 FRONTIS PLAZA BLVD., SUITE 120 FORSYTH COMPREHENSIVE NEUROLOGY, WINSTON-SALEM, NC 27103
(336) 277-2200
(336) 277-2210
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
NC
Other
Enumeration date
09/07/2007
Last updated
09/07/2007
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