Individual
MARGARET WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
415 COLUMBIA RD, DORCHESTER, MA 02125-2424
(617) 740-8077
Mailing address
415 COLUMBIA RD, DORCHESTER, MA 02125-2424
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71860
MA
Other
Enumeration date
02/10/2006
Last updated
07/08/2007
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