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1154577047
DONNA M WALLACE
BRIDGEPORT, CT
NPI
1154577047
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: CT 003840)
Enumeration Date
2008-08-12
Last Update Date
2014-08-22
Business Address
-- DONNA M WALLACE ARPN
46 ALBION ST
BRIDGEPORT, CT 06605-2602
Phone number: 203-330-6000
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Mailing Address
-- DONNA M WALLACE ARPN
46 ALBION ST SOUTHWEST COMMUNITY HEALTH CENTER, INC
BRIDGEPORT, CT 06605-2602
Phone number: 203-332-3155
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