Individual
JONELLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, NP-C
Contact information
Practice address
10175 LITTLE PATUXENT PKWY, COLUMBIA, MD 21044-2655
(800) 328-5979
Mailing address
PO BOX 1459, MINNEAPOLIS, MN 55440-1459
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
11314
CT
Other
Enumeration date
04/06/2023
Last updated
04/06/2023
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