Individual
MRS. TRACEE MARIE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5255 LOUGHBORO RD NW, WASHINGTON, DC 20016-2633
(202) 537-4000
Mailing address
10551 HUNTERS WAY, LAUREL, MD 20723-5723
(505) 573-1388
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA031280
DC
Other
Enumeration date
08/05/2009
Last updated
05/01/2023
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