Individual provider · Type 1 NPI
La' Taysia Wallace, MSN, RN, CPNP-PC
Pediatric Nurse Practitioner · Huntington Station, NY
NPI number
1114297074
Active
Practice location
21 Penny Dr
Huntington Station, NY 11746-3422
Mailing address
PO Box 3644
Mount Vernon, NY 10553-3644
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Registered Nurse | 163W00000X | 716807-1 (NY) |
| Licensed Practical Nurse | 164W00000X | 308886-1 (NY) |
| Pediatric Nurse Practitioner Primary | 363LP0200X | F383676-01 (NY) |
Pediatric Nurse Practitioner: Definition to come...
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About NPI 1114297074
La' Taysia Wallace, MSN, RN, CPNP-PC's National Provider Identifier is 1114297074, issued on Jan 10, 2012. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in Huntington Station, NY. The record was last updated on Apr 2, 2024.