Individual
MISS JENNA MARIE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
8000 E MAPLEWOOD AVE STE 120, GREENWOOD VILLAGE, CO 80111-4766
(303) 438-3999
(720) 439-9500
Mailing address
PO BOX 840862, DALLAS, TX 75284-0862
(303) 377-7638
(303) 780-0787
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
711911
NY
367500000X
Certified Registered Nurse Anesthetist
Primary
APN.0999272-CRNA
CO
Other
Enumeration date
06/22/2021
Last updated
01/02/2025
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