Individual provider · Type 1 NPI

Kent William Wallace, PA-C, ARNP

Surgical Physician Assistant · Everett, WA

NPI number 1770662835 Active

Practice location

1321 Colby Ave, Medical Staff Office (pmg)
Everett, WA 98201-1665

Call (425) 261-2000 Map

Mailing address

PO Box 3360, Providence Health & Services
Portland, OR 97208-3360

Specialties and licenses

TaxonomyCodeLicense
Surgical Physician Assistant Primary 363AS0400XPA10000442 (WA)

Surgical Physician Assistant: Definition to come...

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About NPI 1770662835

Kent William Wallace, PA-C, ARNP's National Provider Identifier is 1770662835, issued on Nov 2, 2006. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Everett, WA. The record was last updated on Feb 6, 2015.