Individual
JORDYN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
700 S HENDERSON RD STE 198, KING OF PRUSSIA, PA 19406-3530
(267) 699-3900
Mailing address
700 S HENDERSON RD STE 108, KING OF PRUSSIA, PA 19406-3530
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
SP024856
PA
Other
Enumeration date
01/10/2022
Last updated
01/10/2022
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