Individual
MRS. ANN MARIE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
22 HICKORY ST, WYANDANCH, NY 11798-4012
(917) 652-1561
Mailing address
22 HICKORY ST, WYANDANCH, NY 11798-4012
(917) 652-1561
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
NY
Other
Enumeration date
08/04/2019
Last updated
08/04/2019
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