Individual
DR. TAMARA JANE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
700 CHILDRENS DR, COLUMBUS, OH 43205-2664
(614) 361-8430
Mailing address
6283 ENCLAVE BLVD, WESTERVILLE, OH 43082-7576
(614) 361-8430
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
01255
OH
363LN0000X
Neonatal Nurse Practitioner
APN0000015454
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003109104C
AMERIGROUP GA
GA
05
—
003109104C
—
GA
05
—
0201101
—
OH
05
—
129252
—
AL
01
—
4299578
TNCARE BLCARE
TN
01
—
606646
WELL CARE
—
Enumeration date
05/09/2008
Last updated
03/28/2022
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