Individual provider · Type 1 NPI

Shawn Michael Wallace, PA-C

Physician Assistant · Rio Rancho, NM

NPI number 1124614706 Active

Practice location

2400 Unser Blvd SE Ste 08100
Rio Rancho, NM 87124

Call (505) 253-6100 Map

Fax (505) 253-6186

Mailing address

PO Box 26666, Phs Provider Enrollment
Albuquerque, NM 87125-6666

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant Primary 363A00000XPA2022-0064 (NM)

Physician Assistant: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, orde…

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About NPI 1124614706

Shawn Michael Wallace, PA-C's National Provider Identifier is 1124614706, issued on Dec 17, 2020. The primary taxonomy on file is Physician Assistant (363A00000X), and the practice location is in Rio Rancho, NM. The record was last updated on Oct 28, 2022.