Individual
ANABEL RAFAELA DISLA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6431 SACKETT ST, PHILADELPHIA, PA 19149
(267) 448-4908
(267) 297-3950
Mailing address
6431 SACKETT ST, PHILADELPHIA, PA 19149
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
SP032861
PA
Other
Enumeration date
05/26/2025
Last updated
07/29/2025
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