Individual
JENNIFER NICOLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2002 DENBURY DR, DUNDALK, MD 21222-4603
(410) 419-7151
Mailing address
2002 DENBURY DR, DUNDALK, MD 21222-4603
(410) 419-7151
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
R197247
MD
Other
Enumeration date
09/14/2021
Last updated
09/14/2021
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