Individual
BEAUTY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
434 EULESS DR, CEDAR HILL, TX 75104-3189
(214) 317-3906
Mailing address
434 EULESS DR, CEDAR HILL, TX 75104-3189
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
668567
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
668567
TEXAS BOARD OF NURSING
TX
Enumeration date
02/16/2018
Last updated
02/16/2018
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