Individual
MRS. MAUREEN KAY WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RNFA
Contact information
Practice address
6624 FANNIN ST, SUITE 2400, HOUSTON, TX 77030-2312
(713) 790-9151
(713) 790-0927
Mailing address
3 REGENT CT, SUGAR LAND, TX 77478-3968
(281) 491-7363
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
579570
TX
Other
Enumeration date
04/09/2007
Last updated
07/08/2007
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