Individual provider · Type 1 NPI

Heather E. Wallace

Gerontology Nurse Practitioner · Macon, GA

NPI number 1053856427 Active

Practice location

535 Coliseum Dr
Macon, GA 31217-0104

Mailing address

PO Box 26698
Macon, GA 31221-6698

Specialties and licenses

TaxonomyCodeLicense
Gerontology Nurse Practitioner Primary 363LG0600XRN197918 (GA)
Nurse Practitioner 363L00000XRN197918 (GA)

Gerontology Nurse Practitioner: Definition to come...

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About NPI 1053856427

Heather E. Wallace's National Provider Identifier is 1053856427, issued on Dec 21, 2016. The primary taxonomy on file is Gerontology Nurse Practitioner (363LG0600X), and the practice location is in Macon, GA. The record was last updated on Dec 27, 2016.