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1902166614
MAVERN WALLACE
VALLEY STREAM, NY
NPI
1902166614
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
163W00000X Registered Nurse
(Licence: NY 584436)
Enumeration Date
2012-05-29
Last Update Date
2012-05-29
Business Address
-- MAVERN WALLACE
13 CLEVELAND ST
VALLEY STREAM, NY 11580-6003
Phone number: 516-823-0739
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Mailing Address
-- MAVERN WALLACE
103 E CARPENTER ST
VALLEY STREAM, NY 11580-4419
Phone number:
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