MRS. PHYLLIS WALLACE, APRN

Nurse Practitioner - Family

Active Individual
NPI: 1366486417

Practice Address

527 W 3RD ST
Konawa, OK 74849

Phone: (580) 925-3286

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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