Individual provider · Type 1 NPI
La Tanya Wallace, FNP
Psychiatric/Mental Health Nurse Practitioner · San Diego, CA
NPI number
1841453487
Active
Practice location
6921 Sperry Ct
San Diego, CA 92111-7030
Fax (888) 425-0508
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Registered Nurse | 163W00000X | 680663 (CA) |
| Nurse Practitioner | 363L00000X | 22485 (CA) |
| Family Nurse Practitioner | 363LF0000X | 680663 (CA) |
| Family Nurse Practitioner | 363LF0000X | 22485 (CA) |
| Psychiatric/Mental Health Nurse Practitioner Primary | 363LP0808X | 22485 (CA) |
Psychiatric/Mental Health Nurse Practitioner: Definition to come...
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About NPI 1841453487
La Tanya Wallace, FNP's National Provider Identifier is 1841453487, issued on Jul 3, 2008. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in San Diego, CA. The record was last updated on Jan 28, 2024.