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1154692523
FELICIA MARIE WALLACE
SOUTHFIELD, MI
NPI
1154692523
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: MI 4704238067)
Enumeration Date
2012-01-18
Last Update Date
2014-02-27
Business Address
-- FELICIA MARIE WALLACE FNP-BC
16001 WEST 9 MILE ROAD
SOUTHFIELD, MI 48075
Phone number: 248-849-2528
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Mailing Address
-- FELICIA MARIE WALLACE FNP-BC
16001 WEST 9 MILE ROAD PROVIDENCE HOSPITAL
SOUTHFIELD, MI 48075
Phone number: 248-849-2528
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