Individual
DR. EVA ALICJA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
267 GRANT ST, BRIDGEPORT, CT 06610-2805
(203) 384-3000
Mailing address
152 KNEEN ST, SHELTON, CT 06484-3935
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
7128
CT
Other
Enumeration date
08/17/2017
Last updated
08/17/2017
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