Individual
RENNA R WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5 DALLY CT, PERTH AMBOY, NJ 08861-2967
(718) 812-9691
Mailing address
5 DALLY CT, PERTH AMBOY, NJ 08861-2967
(718) 812-9691
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
875482
NY
Other
Enumeration date
04/04/2023
Last updated
04/04/2023
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