Individual
SAMANTHA GRACE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1701 UNIVERSITY BLVD, BIRMINGHAM, AL 35233-1815
(205) 934-5428
Mailing address
4688 SANDPIPER LN, HOOVER, AL 35244-3301
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
1-181755
AL
Other
Enumeration date
01/14/2026
Last updated
01/14/2026
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