MEDICARE: ALEXANDRIA WALLACE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1215643846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRIA WALLACE

Provider Business Mailing Address
First Line	:	2051 HEWITT AVE APT 1
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45207-1955
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2051 HEWITT AVE APT 1
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45207-1955
Country	:	US
Telephone Number	:	513-888-6170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2023
Last Update Date	:	01/26/2023

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Directions to “ ALEXANDRIA WALLACE ” Practice Location

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