Individual
LESHONDA TEQUILLA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1725 NEW HANOVER MEDICAL PARK DR, WILMINGTON, NC 28403-5345
(910) 662-9300
(910) 662-9301
Mailing address
PO BOX 936857, ATLANTA, GA 31193-6857
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
5006194
NC
Other
Enumeration date
08/31/2006
Last updated
08/26/2025
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