Individual provider · Type 1 NPI
Kyle Wallace
Adult Health Nurse Practitioner · Bronx, NY
NPI number
1205258258
Active
Practice location
2015 Grand Concourse
Bronx, NY 10453-4303
Fax (718) 537-6180
Mailing address
2626 Halperin Ave
Bronx, NY 10461-2631
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Registered Nurse | 163W00000X | 546269-1 (NY) |
| Adult Health Nurse Practitioner Primary | 363LA2200X | F311097-01 (NY) |
Adult Health Nurse Practitioner: Definition to come...
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About NPI 1205258258
Kyle Wallace's National Provider Identifier is 1205258258, issued on Jan 10, 2014. The primary taxonomy on file is Adult Health Nurse Practitioner (363LA2200X), and the practice location is in Bronx, NY. The record was last updated on Nov 14, 2024.