Individual
MELISSA ANN WALLACE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
RN, CHE
Contact information
Practice address
1060 GAFFNEY RD, #7440 COMMANDER, USA MEDDAC-AK, ATTN: MCUC-MMD-QM, FORT WAINWRIGHT, AK 99703-5001
(907) 353-5418
(907) 353-4845
Mailing address
1060 GAFFNEY RD., #7440 COMMANDER, USA MEDDAC-AK, ATTN: MCUC-MMD-QM, FORT WAINWRIGHT, AK 99703-7440
(907) 353-5418
(907) 353-4845
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
18147
AK
Other
Enumeration date
01/05/2006
Last updated
07/08/2007
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