Individual
DANA MARIE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP FNP-C
Contact information
Practice address
5040 CITY AVE, PHILADELPHIA, PA 19131-1435
(215) 877-2116
Mailing address
25 DUDLEY AVE, LANSDOWNE, PA 19050-2802
(484) 477-5063
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
SP018488
PA
Other
Enumeration date
04/20/2018
Last updated
04/20/2018
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