Individual
SONNY S WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7500 MERCY RD, OMAHA, NE 68124-2319
(855) 524-4001
(402) 398-5589
Mailing address
7500 MERCY RD, OMAHA, NE 68124-2319
(855) 524-4001
(402) 398-5589
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
112565
NE
363L00000X
Nurse Practitioner
H152173
IA
Other
Enumeration date
07/20/2018
Last updated
09/20/2018
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