NPI 1073039897

Betty Ray Wallace

Practitioner Driver Virginia Beach, VA

Practice location

Address: 401 Putnam Rd, Virginia Beach, VA 23462-3146
Phone: (757) 323-9485

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X

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Registry record

NPI: 1073039897
Entity type: Individual
Sex (as registered): Female
NPI issued: 15 Aug 2017
Record last updated: 21 Jul 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.