Individual
MS. TIFFANY BRANDICE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
29699 SOUTHFIELD RD, SOUTHFIELD, MI 48076-2038
(248) 559-5000
Mailing address
29699 SOUTHFIELD RD, SOUTHFIELD, MI 48076-2038
(248) 559-5000
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
4704424595
MI
Other
Enumeration date
11/17/2025
Last updated
01/05/2026
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