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Individual

MRS. BRENDA RENEE WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RN, MSN, ARNP

Contact information

Practice address
1406 ROWANTREE DR, DOVER, FL 33527-4937
(850) 766-9131
(813) 651-3473
Mailing address
1406 ROWANTREE DR, DOVER, FL 33527-4937
(850) 766-9131
(813) 651-3473

Taxonomy

Speciality
Code
Description
License number
State
364SW0102X
Women's Health Clinical Nurse Specialist
Primary
ARNP 9181213
FL

Other

Enumeration date
08/04/2010
Last updated
08/04/2010
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