Individual
MICHELLE MARIE WALLACE I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
17887 STATE ROUTE 58, WELLINGTON, OH 44090-9464
(440) 864-3984
(440) 774-2184
Mailing address
17887 STATE ROUTE 58, WELLINGTON, OH 44090-9464
(440) 864-3984
(440) 774-2184
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
295117
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2259041
—
OH
Enumeration date
03/27/2007
Last updated
07/09/2007
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