Individual provider · Type 1 NPI

Brian Wallace, N.P.

Primary Care Nurse Practitioner · Tyler, TX

NPI number 1457561615 Active

Practice location

1910 Roseland Blvd
Tyler, TX 75701-4246

Specialties and licenses

TaxonomyCodeLicense
Primary Care Nurse Practitioner Primary 363LP2300XRN 169685C (CO)

Primary Care Nurse Practitioner: Definition to come...

18 other providers at this address

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About NPI 1457561615

Brian Wallace, N.P.'s National Provider Identifier is 1457561615, issued on May 23, 2007. The primary taxonomy on file is Primary Care Nurse Practitioner (363LP2300X), and the practice location is in Tyler, TX. The record was last updated on Mar 12, 2010.