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Jacael Wallace
NPI 1992466270 · on the registry since 2022 · sole proprietor
Practice
- Address
- 7409 Colchester Dr
Clinton, MD 20735 - Phone
- (240) 351-5177
Registry record
- Primary taxonomy
- 374J00000X
374J00000X
- Licence states on file
- MD
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2022-01-07
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 Maryland