Individual
JELISA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
101 SIVLEY RD SW, HUNTSVILLE, AL 35801-4421
(256) 265-1000
Mailing address
2306 CUMBERLAND AVE SW, DECATUR, AL 35603-2611
(256) 466-5717
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F06200386
AL
Other
Enumeration date
07/28/2020
Last updated
03/12/2024
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