Individual
MAGGIE MAE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 OFFICE PARK DR, GULF SHORES, AL 36542-3432
(251) 968-7379
(251) 968-5960
Mailing address
200 OFFICE PARK DR, GULF SHORES, AL 36542-3432
(512) 968-7379
(251) 968-5960
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-182953
AL
363LF0000X
Family Nurse Practitioner
8373
CT
Other
Enumeration date
08/13/2019
Last updated
11/13/2023
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