Individual
MARISSA LEANNE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3078 ROUTE 9W STE 100, NEW WINDSOR, NY 12553-6751
(845) 561-3310
(845) 561-8728
Mailing address
3078 ROUTE 9W, SUITE 100, NEW WINDSOR, NY 12553
(845) 561-3310
(845) 561-8728
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
653689-1
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
F308236
NY
Other
Enumeration date
05/01/2012
Last updated
07/21/2022
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