Individual
TWANNA LENITA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
321 JACKSON ST, HAZLEHURST, MS 39083-2113
(601) 500-0027
(601) 277-4039
Mailing address
4083 JOHN I HAY RD, HAZLEHURST, MS 39083-9361
(601) 500-0027
(601) 277-4039
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
MS
Other
Enumeration date
10/02/2018
Last updated
10/02/2018
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