Individual provider · Type 1 NPI
Ciji Deyuana Wallace, RN-FNP
Family Nurse Practitioner · Bogalusa, LA
NPI number
1487455036
Active
Practice location
219 S Border Dr
Bogalusa, LA 70427-3671
Fax (985) 732-4458
Mailing address
PO Box 652
Mc Neill, MS 39457-0652
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 907340 (MS) |
| Family Nurse Practitioner Primary | 363LF0000X | 240977 (LA) |
| Registered Nurse | 163W00000X | 913403 (MS) |
Family Nurse Practitioner: Definition to come...
2 other providers at this address
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About NPI 1487455036
Ciji Deyuana Wallace, RN-FNP's National Provider Identifier is 1487455036, issued on Mar 20, 2025. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Bogalusa, LA. The record was last updated on Oct 14, 2025.