Individual
WINSOME ERICA WALLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4000 DYRE AVE, BRONX, NY 10466-2510
(646) 220-4072
Mailing address
4000 DYRE AVE, BRONX, NY 10466-2510
(646) 220-4072
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
426684
NY
Other
Enumeration date
03/05/2022
Last updated
03/05/2022
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