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NPI Profile for FELICIA M WALLACE in SOUTHFIELD, MI.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Family |
363LF0000X | 50 | Nurse Practitioner |
| NPI Number | 1154692523 |
|
| Status | Active | |
| Credentials | FNP-BC (Family Nurse Practitioner) | |
| Entity | Individual | |
| Enumeration date | 01/18/2012 | |
| Last updated | 02/27/2014 - About 12 years ago | |
| Sole proprietor 1 | No | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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FELICIA M WALLACE
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