Individual
VALERIE ELIZABETH WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
1900 BAYSIDE DR, CHESTER, MD 21619-2840
(410) 490-9498
(410) 834-0291
Mailing address
1900 BAYSIDE DR, CHESTER, MD 21619-2840
(410) 490-9498
(410) 834-0291
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R192586
MD
207Q00000X
Family Medicine Physician
R192586
MD
363LF0000X
Family Nurse Practitioner
Primary
R192586
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R192586
CERTIFIED REGISTERED NURSE PRACTITIONER
MD
Enumeration date
11/13/2018
Last updated
01/26/2026
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