Organization
ISLAND LIFE PERSONALIZED MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAGGIE MAE WALLACE CRNP (NURSE PRACTITIONER)
(251) 842-4287
Entity
Organization
Contact information
Practice address
3817 GULF SHORES PKWY STE 9, GULF SHORES, AL 36542-2781
(251) 842-4287
(251) 235-8232
Mailing address
3817 GULF SHORES PKWY STE 9, GULF SHORES, AL 36542-2781
(251) 842-4287
(251) 235-8232
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/23/2024
Last updated
10/23/2024
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