Individual
TIFFANY MARIE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
999 GARDEN RD, ZANESVILLE, OH 43701-1330
(740) 454-8193
Mailing address
222 10TH ST, MALTA, OH 43758-9383
(740) 297-9779
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
RN.464702
OH
Other
Enumeration date
10/03/2025
Last updated
10/03/2025
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