Individual provider · Type 1 NPI

Cynthia Wallace, AGPCNP

Gerontology Nurse Practitioner · Medford, OR

NPI number 1811393648 Active

Practice location

1111 Crater Lake Ave
Medford, OR 97504-6241

Fax (541) 732-5251

Mailing address

PO Box 3308
Portland, OR 97208-3308

Specialties and licenses

TaxonomyCodeLicense
Gerontology Nurse Practitioner Primary 363LG0600X201500016NP-PP (OR)

Gerontology Nurse Practitioner: Definition to come...

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About NPI 1811393648

Cynthia Wallace, AGPCNP's National Provider Identifier is 1811393648, issued on Nov 5, 2014. The primary taxonomy on file is Gerontology Nurse Practitioner (363LG0600X), and the practice location is in Medford, OR. The record was last updated on Sep 30, 2020.