Individual
MRS. CIJI DEYUANA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN-FNP
Contact information
Practice address
219 S BORDER DR, BOGALUSA, LA 70427-3671
(985) 633-1952
(985) 732-4458
Mailing address
PO BOX 652, MC NEILL, MS 39457-0652
(601) 215-6976
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
913403
MS
363LF0000X
Family Nurse Practitioner
Primary
240977
LA
363LF0000X
Family Nurse Practitioner
907340
MS
Other
Enumeration date
03/20/2025
Last updated
10/14/2025
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