Individual
AMANDA GAIL WALLACE
Active
Individual
AMANDA GAIL WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1155351
KY
163W00000X
Registered Nurse
RN.300987
OH
363LF0000X
Family Nurse Practitioner
3011658
KY
363LF0000X
Family Nurse Practitioner
Primary
APRN.CNP.021126
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0241010
—
OH
05
—
7100477320
—
KY
Enumeration date
07/21/2017
Last updated
05/05/2023
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