Individual
DONNA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1 PARKLANE BLVD STE E200, DEARBORN, MI 48126-2400
(586) 204-5560
Mailing address
27085 GRATIOT AVE STE 101, ROSEVILLE, MI 48066-2984
(586) 204-5560
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
09/21/2023
Last updated
09/21/2023
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