Individual
MRS. JESSICA RENEE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Contact information
Practice address
1821 E. HIGH ST., SPRINGFIELD, OH 45505
(937) 323-7340
(937) 323-3363
Mailing address
1821 E. HIGH ST., SPRINGFIELD, OH 45505
(937) 323-7340
(937) 323-3363
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
021995
OH
Other
Enumeration date
07/04/2018
Last updated
01/03/2019
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