Individual
STEPHANIE LOUISE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6701 N CHARLES ST STE 4226, TOWSON, MD 21204-6808
(410) 296-4616
(410) 337-5068
Mailing address
1122 KENILWORTH DR STE 317, BALTIMORE, MD 21204-2146
(410) 296-4616
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R160036
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
570079500
—
MD
Enumeration date
02/05/2010
Last updated
02/03/2023
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