Individual
DELICIA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12707 FOWLER CIR, OMAHA, NE 68164-1725
(402) 917-3602
Mailing address
12707 FOWLER CIR, OMAHA, NE 68164-1725
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
—
Other
Enumeration date
01/02/2025
Last updated
01/02/2025
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