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Madison Wallace
NPI 1407452501 · on the registry since 2020
Practice
- Address
- 1691 Pontiac St
Denver, CO 80220 - Phone
- (843) 861-8922
Registry record
- Primary taxonomy
- 1041C0700X
1041C0700X
- Also registered as
- 101Y00000X
1041C0700X - Licence states on file
- CO, CT
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2023-08-07
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Colorado