Individual
DONNA C WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
2910 N 3RD AVE, PHOENIX, AZ 85013-4434
(602) 406-3632
(602) 406-6126
Mailing address
2910 N 3RD AVE, PHOENIX, AZ 85013-4434
(602) 406-3632
(602) 406-6126
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
RN041572
AZ
Other
Enumeration date
09/27/2005
Last updated
09/03/2014
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