| NPI | 1447274345 |
|---|---|
| Former Name | JANELLE TIANNA WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 2890) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 2890) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2014-11-12 |