Individual
MRS. DEANNA ELENA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7616 BRANFORD PL STE 320, SUGAR LAND, TX 77479-3794
(819) 801-7422
Mailing address
12553 GULF FWY, HOUSTON, TX 77034-4509
(281) 481-8557
(281) 481-2676
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
TX
Other
Enumeration date
02/11/2009
Last updated
07/28/2021
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