Individual
MRS. JESSICA NICOLE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
655 FRONT ST, MIDDLEPORT, OH 45760
(740) 416-5643
Mailing address
655 FRONT ST, MIDDLEPORT, OH 45760
(740) 416-5643
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
SL987156
OH
Other
Enumeration date
03/25/2008
Last updated
03/25/2008
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