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General NPI Number Information
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NPI Number | 1609221431
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Entity Type | Organization
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Legal Business Name | PAUL WALLACE MANAGEMENT INC
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Dates
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Enumeration Date | 04/29/2016
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Last Update Date | 04/29/2016
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Provider Practice Location Address
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Address Line | 7956 TWIST LN F
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City | SPRINGFIELD
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State | VA
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Zip | 22153-2823
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Country | US
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Telephone | 703-451-8062
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Fax | 703-569-4127
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Provider Business Mailing Address
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Address Line | 7956 TWIST LN F
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City | SPRINGFIELD
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State | VA
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Zip | 22153-2823
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Country | US
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Telephone | 703-451-8062
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Fax | 703-569-4127
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Authorized Official
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Title or Position | PRESIDENT
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Name | NANCY MESHESHA
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Credential |
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Telephone | 703-477-5548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number | 10220
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License Number State | VA
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