Individual provider · Type 1 NPI
Shannon L. Wallace, FNP-BC, PMHNP-BC
Psychiatric/Mental Health Nurse Practitioner · Indianapolis, IN
NPI number
1851481584
Active
Practice location
1481 W 10th St
Indianapolis, IN 46202-2803
Mailing address
12670 N Rainey Rd W
Syracuse, IN 46567-9784
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 71001501 (IN) |
| Psychiatric/Mental Health Nurse Practitioner Primary | 363LP0808X | 71001501 (IN) |
Psychiatric/Mental Health Nurse Practitioner: Definition to come...
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About NPI 1851481584
Shannon L. Wallace, FNP-BC, PMHNP-BC's National Provider Identifier is 1851481584, issued on Oct 13, 2006. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Indianapolis, IN. The record was last updated on Sep 27, 2022.