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General NPI Number Information
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NPI Number | 1689110918
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Entity Type | Individual
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Provider Name | JAMIE RENEE' WALLACE RN, BSN
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Gender | Female
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Dates
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Enumeration Date | 01/10/2017
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 201 - HOSPITAL DRIVE
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City | DOVER
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State | OH
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Zip | 44622
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Country | US
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Telephone | 330-343-6631
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Fax | 330-343-8188
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Provider Business Mailing Address
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Address Line | 201 - HOSPITAL DRIVE
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City | DOVER
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State | OH
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Zip | 44622
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Country | US
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Telephone | 330-343-6631
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Fax | 330-343-8188
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN.287814
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License Number State | OH
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