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1114379708
NICHOLE WALLACE
BROOKLYN, NY
NPI
1114379708
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363AM0700X Physician Assistant Medical
Enumeration Date
2016-07-06
Last Update Date
2023-08-18
Business Address
MRS. NICHOLE WALLACE PA
760 BROADWAY
BROOKLYN, NY 11206-5317
Phone number: 718-312-2312
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Mailing Address
MRS. NICHOLE WALLACE PA
833 PENFIELD ST
BRONX, NY 10470-1322
Phone number: 718-708-1913
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