IndividualActive
Jarred Wallace, RN
NPI 1710609045 · Emergency Registered Nurse · Detroit, MI
Provider details
- NPI number
- 1710609045
- Entity type
- Individual
- Primary specialty
- Emergency Registered NurseNursing Service Providers
- Credential
- RN
- Sex
- Male
- Sole proprietor
- No
- License
- 4704321978 (MI)
Specialties & taxonomies
Nursing Service Providers
Practice location
4646 John R St
Detroit, MI 48201-1916
Phone: (313) 576-4436
Approximate (ZIP-level) locationGet directions
Mailing address
4618 Meigs Ave
Waterford, MI 48329-1819
Registry dates
- Enumerated
- 2022-09-14
- Last updated
- 2022-10-18
- Certified
- 2022-10-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.