Individual
MS. SARA ELIZABETH WALLACE-KEESHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
2144 CECIL B MOORE AVE, PHILADELPHIA, PA 19121-4014
(215) 320-6187
Mailing address
2650 AGATE ST, PHILADELPHIA, PA 19125-2302
(864) 275-4820
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
SP027631
PA
Other
Enumeration date
06/08/2023
Last updated
06/08/2023
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