Individual
JENA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
322 MULBERRY ST SW STE A, LENOIR, NC 28645-5703
(828) 757-6460
(828) 759-4901
Mailing address
1853 18TH STREET CT NE, HICKORY, NC 28601-0533
(860) 334-2475
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
253837
NC
Other
Enumeration date
05/17/2016
Last updated
03/17/2021
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