Individual
MISS GINA MARIE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
42 FLORENCE AVE, PAINESVILLE, OH 44077-1120
(440) 413-0508
Mailing address
42 FLORENCE AVE, PAINESVILLE, OH 44077-1120
(440) 414-0508
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2442619
PROVIDER NUMBER
OH
Enumeration date
04/18/2007
Last updated
07/08/2007
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