Individual
MRS. TIFFANY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
719 GREEN VALLEY RD, GREENSBORO, NC 27408-7014
(336) 275-5391
(336) 275-4702
Mailing address
8552 DALTON RIDGE RD, KERNERSVILLE, NC 27284-7276
(336) 302-6180
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5013821
NC
Other
Enumeration date
11/24/2020
Last updated
08/19/2021
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