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Individual

MAUREEN A WALLACE-KING

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
9500 EUCLID AVE, CLEVELAND, OH 44195-0001
(216) 636-1619
Mailing address
1380 KINGSWAY, WESTLAKE, OH 44145-2611
(440) 525-6500

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN178999
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000234659
UNISON
OH
01
000000558051
ANTHEM
OH
05
2806422
OH
01
9985125
AETNA
OH
Enumeration date
03/28/2008
Last updated
02/05/2013
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