Individual
JORDAN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
503 E MCDONALD AVE, MAN, WV 25635-1014
(304) 687-0172
Mailing address
503 E MCDONALD AVE, MAN, WV 25635-1014
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
06/30/2025
Last updated
06/30/2025
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