Individual provider · Type 1 NPI
Robert Wallace, PA, NP
Family Nurse Practitioner · Oakland, CA
NPI number
1720315336
Active
Practice location
747 52nd St
Oakland, CA 94609-1809
Fax (510) 428-3022
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant | 363A00000X | PA20650 (CA) |
| Family Nurse Practitioner Primary | 363LF0000X | 19738 (CA) |
Family Nurse Practitioner: Definition to come...
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About NPI 1720315336
Robert Wallace, PA, NP's National Provider Identifier is 1720315336, issued on Nov 3, 2009. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Oakland, CA. The record was last updated on Jun 11, 2012.