Individual provider · Type 1 NPI
Marissa Leanne Wallace, NP
Adult Health Nurse Practitioner · New Windsor, NY
NPI number
1689932360
Active
Practice location
3078 Route 9W Ste 100
New Windsor, NY 12553-6751
Fax (845) 561-8728
Mailing address
3078 Route 9W, Suite 100
New Windsor, NY 12553
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Registered Nurse | 163W00000X | 653689-1 (NY) |
| Adult Health Nurse Practitioner Primary | 363LA2200X | F308236 (NY) |
Adult Health Nurse Practitioner: Definition to come...
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About NPI 1689932360
Marissa Leanne Wallace, NP's National Provider Identifier is 1689932360, issued on May 1, 2012. The primary taxonomy on file is Adult Health Nurse Practitioner (363LA2200X), and the practice location is in New Windsor, NY. The record was last updated on Jul 21, 2022.