Individual
VARRE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
27777 INKSTER RD, FARMINGTON HILLS, MI 48334-5326
(248) 299-0030
Mailing address
27777 INKSTER RD, FARMINGTON HILLS, MI 48334-5326
(248) 299-0030
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703101283
MI
Other
Enumeration date
05/31/2019
Last updated
05/31/2019
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