Individual
MRS. STEPHANIE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1625 N CAMPBELL AVE, TUCSON, AZ 85719-4330
(520) 694-0111
Mailing address
3870 W WILD HORSE PL, TUCSON, AZ 85741-1906
(520) 307-9417
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6214
AZ
Other
Enumeration date
10/08/2015
Last updated
01/20/2020
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