Individual
REBECCA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
3838 S 700 E, SUITE 200, SALT LAKE CITY, UT 84106-1466
(801) 261-4988
(801) 269-9427
Mailing address
1837 HOLLYWOOD AVE, SALT LAKE CITY, UT 84108-3103
(801) 487-4160
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
216162-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D1948
—
UT
Enumeration date
09/06/2005
Last updated
11/24/2008
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