Individual
MS. DANIELLE RENEE WALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
231 ROWLEE RD, FULTON, NY 13069-4271
(315) 598-8263
Mailing address
231 ROWLEE RD, FULTON, NY 13069-4271
(315) 598-8263
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
276466
NY
Other
Enumeration date
08/30/2010
Last updated
08/30/2010
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