Individual
PAIGE MARIE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1301 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2122
(817) 291-4545
Mailing address
1301 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2122
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
AP143787
TX
Other
Enumeration date
12/19/2019
Last updated
12/19/2019
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