Individual
CHRISTIAN ALEXANDER WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
507 N 17TH STREET, MILWAUKEE, WI 53233
(414) 288-5688
Mailing address
507 NORTH 17TH STREET, MILWAUKEE, WI 53233
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5111
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/17/2022
Last updated
11/21/2022
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