Individual provider · Type 1 NPI

Holly A. Wallace, APNP

Nurse Practitioner · Summit, WI

NPI number 1124660592 Active

Practice location

36500 Aurora Dr
Summit, WI 53066-4899

Fax (262) 434-5050

Mailing address

PO Box 735044
Chicago, IL 60673-5044

Other practice locations

  • 2428 N Grandview Blvd Ste 102, Waukesha, WI 53188-6906 · (262) 875-5070

Specialties and licenses

TaxonomyCodeLicense
Nurse Practitioner Primary 363L00000X9679 (WI)

Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…

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About NPI 1124660592

Holly A. Wallace, APNP's National Provider Identifier is 1124660592, issued on Oct 17, 2019. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Summit, WI. The record was last updated on Oct 24, 2025.