Individual
MRS. TEMEKA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
800 SUSAN TART RD, DUNN, NC 28334-5506
(910) 892-8892
(910) 892-1063
Mailing address
800 SUSAN TART RD, DUNN, NC 28334-5506
(910) 892-8892
(910) 892-1063
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
001006945
NC
Other
Enumeration date
01/18/2017
Last updated
01/18/2017
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