Individual provider · Type 1 NPI
Lourdes Ivette Wallace, AGACNP-BC
Adult Health Nurse Practitioner · Boerne, TX
NPI number
1659773869
Active
Practice location
113 Pleasant Valley Dr Ste 210
Boerne, TX 78006-5683
Fax (830) 267-4575
Other practice locations
- 10004 Johns Rd, Boerne, TX 78006-8811 · (830) 267-4575
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner | 363L00000X | RN860816 (TX) |
| Adult Health Nurse Practitioner | 363LA2200X | 11670071-4405 (UT) |
| Gerontology Nurse Practitioner | 363LG0600X | AP126548 (TX) |
| Gerontology Nurse Practitioner | 363LG0600X | 11670071-4405 (UT) |
| Adult Health Nurse Practitioner Primary | 363LA2200X | AP126548 (TX) |
Adult Health Nurse Practitioner: Definition to come...
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About NPI 1659773869
Lourdes Ivette Wallace, AGACNP-BC's National Provider Identifier is 1659773869, issued on Sep 18, 2014. The primary taxonomy on file is Adult Health Nurse Practitioner (363LA2200X), and the practice location is in Boerne, TX. The record was last updated on Sep 3, 2020.