Individual
MRS. SANDRA MARIE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
180 7TH AVE, BROOKLYN, NY 11203
(718) 499-2412
Mailing address
180 7TH AVE, BROOKLYN, NY 11215-2609
(718) 499-2412
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
441751-1
NY
Other
Enumeration date
03/29/2012
Last updated
03/29/2012
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