Individual
ASHLEY WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
29615 HANOVER BLVD, WESTLAND, MI 48186-5179
(734) 560-3074
Mailing address
29615 HANOVER BLVD, WESTLAND, MI 48186-5179
(734) 560-3074
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703110011
MI
Other
Enumeration date
09/30/2014
Last updated
09/30/2014
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