Individual
MRS. DIONNE LANETTE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN RN CNL
Contact information
Practice address
15730 MOK AVE, EASTPOINTE, MI 48021-2367
(586) 241-7088
(585) 585-9555
Mailing address
15730 MOK AVE, EASTPOINTE, MI 48021-2367
(586) 241-7088
(585) 585-9555
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
4704260135
MI
163WP0808X
Psychiatric/Mental Health Registered Nurse
4704260135
MI
Other
Enumeration date
09/15/2017
Last updated
05/11/2023
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