Individual provider · Type 1 NPI
Phyllis A. Wallace, APRN
Family Nurse Practitioner · Konawa, OK
NPI number
1366486417
Active
Practice location
527 W 3rd St
Konawa, OK 74849-1415
Fax (580) 925-9149
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Women's Health Nurse Practitioner | 363LW0102X | R0035497 (OK) |
| Family Nurse Practitioner Primary | 363LF0000X | 35497 (OK) |
Family Nurse Practitioner: Definition to come...
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About NPI 1366486417
Phyllis A. Wallace, APRN's National Provider Identifier is 1366486417, issued on Jun 16, 2006. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Konawa, OK. The record was last updated on Nov 22, 2021.