NPI 1083083455

Augie Wallace

Practitioner Home Health Aide Upper Darby, PA

Practice location

Address: 8600 W Chester Pike STE 308, Upper Darby, PA 19082-2629
Phone: (484) 433-8208
Mailing address: 4312 Main St APT 316, Philadelphia, PA 19127-1531

Registered specialties

Home Health Aide Primary

Nursing Service Related Providers Taxonomy 374U00000X Licence 28613601 (PA)

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Registry record

NPI: 1083083455
Entity type: Individual
Sex (as registered): Male
NPI issued: 16 Sep 2015
Record last updated: 13 Sep 2021

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.