Individual
SHARON D WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
673 WOODLAND SQUARE LOOP SE STE 320, LACEY, WA 98503-1066
(425) 640-7009
Mailing address
673 WOODLAND SQUARE LOOP SE STE 320, LACEY, WA 98503-1066
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP61462632
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/08/2019
Last updated
03/19/2026
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