Provider Demographics
NPI:1801465133
Name:WALLACE, SHAMIKA D (RN, BSN, CWC)
Entity type:Individual
Prefix:
First Name:SHAMIKA
Middle Name:D
Last Name:WALLACE
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Gender:F
Credentials:RN, BSN, CWC
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Mailing Address - Street 1:2852 PARKROW LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-3537
Mailing Address - Country:US
Mailing Address - Phone:408-781-7680
Mailing Address - Fax:
Practice Address - Street 1:2852 PARKROW LN
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-3537
Practice Address - Country:US
Practice Address - Phone:408-781-7680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
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