Individual
DR. TAMARA JANE WALLACE
Active
Individual
DR. TAMARA JANE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
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
Update your record
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