Provider Demographics
NPI:1780410779
Name:WALLACE, RASHEADA LYNN ((CD,PCD))
Entity type:Individual
Prefix:
First Name:RASHEADA
Middle Name:LYNN
Last Name:WALLACE
Suffix:
Gender:F
Credentials:(CD,PCD)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E PHIL ELLENA ST FL 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2222
Mailing Address - Country:US
Mailing Address - Phone:267-231-4615
Mailing Address - Fax:
Practice Address - Street 1:1609 MURDOCH RD FL 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-1011
Practice Address - Country:US
Practice Address - Phone:267-231-4615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula