Individual provider · Type 1 NPI

Jelisa Wallace, CRNP

Family Nurse Practitioner · Huntsville, AL

NPI number 1649889478 Active

Practice location

101 Sivley Rd SW
Huntsville, AL 35801-4421

Mailing address

2306 Cumberland Ave SW
Decatur, AL 35603-2611

Specialties and licenses

TaxonomyCodeLicense
Family Nurse Practitioner Primary 363LF0000XF06200386 (AL)

Family Nurse Practitioner: Definition to come...

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About NPI 1649889478

Jelisa Wallace, CRNP's National Provider Identifier is 1649889478, issued on Jul 28, 2020. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Huntsville, AL. The record was last updated on Mar 12, 2024.