Individual
ELLEN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6701 N CHARLES ST STE 2372, TOWSON, MD 21204-6808
(443) 849-2408
Mailing address
118 MARGATE RD, LUTHERVILLE, MD 21093-5839
(410) 804-9329
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R072820
MD
Other
Enumeration date
11/06/2013
Last updated
01/22/2018
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