Individual
ERIN NICOLE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
257 HOSPITAL DR NE STE 101, BOLIVIA, NC 28422-8411
(910) 721-4100
(910) 721-4101
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2024-01330
NC
207R00000X
Internal Medicine Physician
83639
SC
Other
Enumeration date
05/06/2021
Last updated
08/08/2024
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