Individual
DANIELLE MARIE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6720 RITCHIE HWY STE F, GLEN BURNIE, MD 21061-2892
(667) 406-0782
Mailing address
338 JENNINGS RD, SEVERNA PARK, MD 21146-1802
(410) 913-7927
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R268707
MD
Other
Enumeration date
09/20/2024
Last updated
09/20/2024
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