Stacy Wallace is a Driver based in Toledo, OH. Stacy Wallace practices in Toledo, OH. The NPI Number for Stacy Wallace is 1386264109 and holds a License No. RX730744 (Ohio).
The current practice location address for Stacy Wallace is 324 Kenilworth Ave, Toledo, OH and can be reached out via phone at 419-810-0900.
Location: 324 Kenilworth Ave, Toledo, OH, 43610-1456
Provider Profile Details
NPI Number
1386264109
Provider Name
Stacy Wallace
Credential
Provider Entity Type
Individual
Gender
Female
Address
324 Kenilworth Ave, Toledo, OH, 43610-1456
Phone Number
419-810-0900
Fax Number
Provider Enumeration Date
04/22/2020
Last Update Date
03/10/2024
Provider's Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 85052075 | 05 | OH |
Provider Business Practice Location Address Details
Address
324 Kenilworth Ave
City
State
Zip
43610-1456
Phone Number
419-810-0900
Fax Number
Provider Business Mailing Address Details
Address
324 Kenilworth Ave
City
State
Zip
43610-1456
Phone Number
419-810-0900
Fax Number
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Driver
Speciality
-
Taxonomy
License No.
RX730744 (Ohio)
Definition
A person employed to operate a motor vehicle as a carrier of persons or property.
Badge
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