Individual
TONYA MICHELLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
1401 ASHWAY ST, CONROE, TX 77385-9704
(713) 907-6719
Mailing address
602 W SEMANDS ST, CONROE, TX 77301-1867
(936) 756-5598
Taxonomy
Speciality
Code
Description
License number
State
2080T0002X
Pediatric Medical Toxicology Physician
Primary
323378
TX
Other
Enumeration date
08/01/2018
Last updated
08/01/2018
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