Individual
KISHA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1 GUSTAVE L LEVY PL, NEW YORK, NY 10029-6504
(212) 241-6500
(212) 426-5040
Mailing address
150 E 42ND ST # 3000, NEW YORK, NY 10017-5612
(646) 605-8119
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F308252
NY
Other
Enumeration date
07/17/2018
Last updated
06/09/2021
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