Individual
MR. WILLIAM S WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APNP
Contact information
Practice address
1100 GATEWAY CT, WEST BEND, WI 53095-8539
(262) 335-8600
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2475
WI
363LF0000X
Family Nurse Practitioner
KS44943
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36030600
—
WI
05
—
PENDING
—
KS
Enumeration date
03/03/2006
Last updated
06/13/2025
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