Individual
MARZETTE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1330 N CLASSEN BLVD, SUITE 306, OKLAHOMA CITY, OK 73106-6835
(405) 694-4053
(405) 225-7326
Mailing address
6103 N MERIDIAN AVE, APT 114, OKLAHOMA CITY, OK 73112-1255
(405) 635-7512
(405) 225-7326
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
11/05/2015
Last updated
11/05/2015
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