MRS. PHYLLIS WALLACE, APRN
Nurse Practitioner - Family
Active
Individual
NPI: 1366486417
Specialties
| Specialty | Code | Primary | License |
|---|---|---|---|
| Nurse Practitioner - Women's Health | 363LW0102X | No | R0035497 (OK) |
| Nurse Practitioner - Family | 363LF0000X | Yes | 35497 (OK) |
Frequently Asked Questions
NPI 1366486417 is the National Provider Identifier for MRS. PHYLLIS WALLACE, APRN, a Nurse Practitioner - Family provider located in Konawa, OK. This NPI was enumerated on June 16, 2006.
MRS. PHYLLIS WALLACE, APRN practices at 527 W 3RD ST, Konawa, OK 74849.
Quick Facts
- NPI
- 1366486417
- Type
- Individual
- Enumerated
- Jun 16, 2006
- Last Updated
- Nov 22, 2021
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