Individual
DUSTIN W WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
833 PRINCETON AVE SW, POB III; SUITE 200A, BIRMINGHAM, AL 35211-1323
(205) 786-2776
Mailing address
833 PRINCETON AVE SW, POB III; SUITE 200A, BIRMINGHAM, AL 35211-1323
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1-133041
AL
Other
Enumeration date
11/02/2015
Last updated
11/02/2015
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