Individual provider · Type 1 NPI
Scott David Wallace, NP
Family Nurse Practitioner · Fairfield, CA
NPI number
1790442408
Active
Practice location
513 Silverado Cir
Fairfield, CA 94534-6818
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Nurse Practitioner Primary | 363LF0000X | 459083 (CA) |
Family Nurse Practitioner: Definition to come...
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About NPI 1790442408
Scott David Wallace, NP's National Provider Identifier is 1790442408, issued on Nov 17, 2021. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Fairfield, CA. The record was last updated on Nov 17, 2021.