Individual provider · Type 1 NPI
Kisha Wallace
Adult Health Nurse Practitioner · New York, NY
NPI number
1417433939
Active
Practice location
1 Gustave L Levy Pl
New York, NY 10029-6504
Fax (212) 426-5040
Mailing address
150 E 42nd St # 3000
New York, NY 10017-5612
Other practice locations
- 320 Wilson St, West Hempstead, NY 11552-2019 · (516) 485-5864
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Adult Health Nurse Practitioner Primary | 363LA2200X | F308252 (NY) |
Adult Health Nurse Practitioner: Definition to come...
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About NPI 1417433939
Kisha Wallace's National Provider Identifier is 1417433939, issued on Jul 17, 2018. The primary taxonomy on file is Adult Health Nurse Practitioner (363LA2200X), and the practice location is in New York, NY. The record was last updated on Jun 9, 2021.