Individual
TONYA MICHELLE WALLACE
Active
Individual
TONYA MICHELLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
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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