Individual provider · Type 1 NPI
Lisa Wallace, RN
Psychiatric/Mental Health Nurse Practitioner · Mather, CA
NPI number
1720476641
Active
Practice location
10535 Hospital Way
Mather, CA 95655-4200
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Registered Nurse | 163W00000X | 821591 (CA) |
| Psychiatric/Mental Health Nurse Practitioner Primary | 363LP0808X | 95006507 (CA) |
Psychiatric/Mental Health Nurse Practitioner: Definition to come...
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About NPI 1720476641
Lisa Wallace, RN's National Provider Identifier is 1720476641, issued on Dec 30, 2014. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Mather, CA. The record was last updated on Nov 12, 2021.