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Individual

JOAN WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
297 PROMENADE ST, PROVIDENCE, RI 02908-5720
(401) 490-6464
Mailing address
297 PROMENADE ST, PROVIDENCE, RI 02908-5720
(401) 490-6464

Taxonomy

Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
NPP20834
RI

Other

Enumeration date
10/02/2006
Last updated
10/11/2007
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