Individual provider · Type 1 NPI

Autumn Renee Wallace

Student in an Organized Health Care Education/Training Program · Grand Rapids, MI

NPI number 1801629720 Active

Practice location

2013 Eastcastle Dr SE Ste B
Grand Rapids, MI 49508-8873

Call (616) 888-1120 Map

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1801629720

Autumn Renee Wallace's National Provider Identifier is 1801629720, issued on Aug 26, 2024. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Grand Rapids, MI. The record was last updated on Aug 26, 2024.