| NPI | 1336816792 |
|---|---|
| Former Name | SHALEE MARIAH WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1035030) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1035030) |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2023-06-06 |