Individual
MRS. SARA JANE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1450 CHAPEL ST, NEW HAVEN, CT 06511-4405
(203) 789-3000
Mailing address
512 SCENIC RD, ORANGE, CT 06477-2127
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
001693
CT
Other
Enumeration date
07/14/2006
Last updated
07/08/2007
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