Individual provider · Type 1 NPI

Cassandra Marie Wallace, PNP

Pediatric Nurse Practitioner · St. Louis, MO

NPI number 1417354440 Active

Practice location

1 Childrens Pl, Div Ped Emergency Med
St. Louis, MO 63110-1002

Call (314) 454-2341 Map

Fax (314) 454-4345

Mailing address

PO Box 7412011
Chicago, IL 60674-2011

Specialties and licenses

TaxonomyCodeLicense
Pediatric Nurse Practitioner Primary 363LP0200X2014038394 (MO)

Pediatric Nurse Practitioner: Definition to come...

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About NPI 1417354440

Cassandra Marie Wallace, PNP's National Provider Identifier is 1417354440, issued on Nov 19, 2014. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in St. Louis, MO. The record was last updated on Apr 17, 2025.