MAVERN WALLACE

VALLEY STREAM, NY
NPI1902166614
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy163W00000X Registered Nurse
(Licence: NY  584436)
Enumeration Date2012-05-29
Last Update Date2012-05-29
Business Address
-- MAVERN WALLACE
13 CLEVELAND ST
VALLEY STREAM, NY 11580-6003
Phone number: 516-823-0739
Mailing Address
-- MAVERN WALLACE
103 E CARPENTER ST
VALLEY STREAM, NY 11580-4419
Phone number: