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Individual

NICOLE MARIE WALLACE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PT

Contact information

Practice address
913 FIRST COLONIAL RD STE 204, VIRGINIA BEACH, VA 23454-3198
(757) 550-0725
Mailing address
913 FIRST COLONIAL RD STE 204, VIRGINIA BEACH, VA 23454-3198
(757) 550-0725

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
282NC2000X
Children's Hospital
2305203070
VA

Other

Enumeration date
05/08/2007
Last updated
03/18/2019
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