Individual provider · Type 1 NPI

Stacy Wallace, NP

Pediatric Nurse Practitioner · San Antonio, TX

NPI number 1205843422 Active

Practice location

1702 N Alamo St, Suite 220
San Antonio, TX 78215-1201

Call (210) 224-1823 Map

Fax (210) 224-7011

Specialties and licenses

TaxonomyCodeLicense
Pediatric Nurse Practitioner Primary 363LP0200X624860 (TX)

Pediatric Nurse Practitioner: Definition to come...

2 other providers at this address

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About NPI 1205843422

Stacy Wallace, NP's National Provider Identifier is 1205843422, issued on Aug 1, 2006. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in San Antonio, TX. The record was last updated on Jan 27, 2010.