Individual
LEQUANA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
30364 PENNINGTON LN, NOVI, MI 48377-1740
(313) 737-8900
(734) 585-5259
Mailing address
30364 PENNINGTON LN, NOVI, MI 48377-1740
(313) 737-8900
(734) 585-5259
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
MI
Other
Enumeration date
05/11/2023
Last updated
01/20/2026
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