Individual
BRANDY S WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6823 SAINT CHARLES AVE BLDG 92, NEW ORLEANS, LA 70118-5665
(504) 865-5255
Mailing address
41 COUNTY ROAD 127, QUITMAN, MS 39355-9668
(601) 616-1864
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
215880
LA
363LF0000X
Family Nurse Practitioner
903712
MS
Other
Enumeration date
01/22/2020
Last updated
10/12/2020
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