Individual
NAOMI SUSAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
912 S FLEISHEL AVE, TYLER, TX 75701-2018
(903) 592-6901
Mailing address
912 S FLEISHEL AVE, TYLER, TX 75701-2018
(903) 592-6901
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1128446
TX
Other
Enumeration date
08/07/2023
Last updated
08/07/2023
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