Wallace, Stacy
Wallace, Stacy is an sole proprietor health care provider with primary practice located at 324 Kenilworth Ave , Toledo OH 43610-1456. She recently has only one registered license in Other Service Providers / Driver, which is considered as her primary health care specialty. Wallace, Stacy can be contacted via phone (419) 810-0900.Contact Information
Primary practice address
324 Kenilworth Ave
Toledo OH 43610-1456
Phone: (419) 810-0900
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Driver | 172A00000X | RX730744 | Ohio |
Profile Details
| NPI number | 1386264109 |
|---|---|
| LBN Legal business name | Wallace, Stacy |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 22nd, 2020 |
| Last updated | Apr 22nd, 2020 - about 4 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1386264109 | NPPES |
| Ohio | MEDICAID | 85052075 |
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