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1588946214
MICAH R WALLACE
LATROBE, PA
NPI
1588946214
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363AS0400X Physician Assistant, Surgical
(Licence: PA MA054581)
Enumeration Date
2011-09-20
Last Update Date
2018-12-21
Business Address
Ms. MICAH R WALLACE PA-C
100 EXCELA HEALTH DR STE 102
LATROBE, PA 15650-9001
Phone number: 724-804-1760
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Mailing Address
Ms. MICAH R WALLACE PA-C
520 JEFFERSON AVE SUITE 400
JEANNETTE, PA 15644-2538
Phone number: 724-527-8060
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