Individual
BRITTANY ASTA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
510 NORTH STREET, PITTSFIELD, MA 01201
(413) 447-2351
(413) 445-7009
Mailing address
P.O. BOX 30, GREAT BARRINGTON, MA 01230
(413) 528-9311
(413) 644-0274
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN2258013
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110120598A
—
MA
Enumeration date
09/23/2013
Last updated
07/21/2022
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