Individual
JENNIFER MARIE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
202 CABOT CT, DEPTFORD, NJ 08096-5114
(856) 885-4579
Mailing address
36 WALKER RD, WEST ORANGE, NJ 07052-4403
(973) 715-5586
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
26NJ01341100
NJ
Other
Enumeration date
08/02/2022
Last updated
08/02/2022
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