Wallace, Jacqueline

Wallace, Jacqueline is an individual health care provider with primary practice located at 530 N Main St , Providence RI 02904-5762. She recently has only one registered license in Nursing Service Providers / Registered Nurse, which is considered as her primary health care specialty. Wallace, Jacqueline can be contacted via phone (401) 276-4100.

Contact Information

Primary practice address
530 N Main St Providence RI 02904-5762
Phone: (401) 276-4100
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X RN12564 Rhode Island

Profile Details

NPI number 1710920376
LBN Legal business name Wallace, Jacqueline
Credentials Registered Nurse (RN)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 13th, 2006
Last updated Jul 25th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710920376 NPPES
Rhode Island MEDICAID JW03509
Rhode Island Other 1104847946

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