Individual
DR. NICHOLE G WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
13123 E 16TH AVE, B390, AURORA, CO 80045-7106
(303) 864-5250
Mailing address
PO BOX 110429, AURORA, CO 80042-0429
(303) 493-7000
Taxonomy
Speciality
Code
Description
License number
State
2080C0008X
Child Abuse Pediatrics Physician
Primary
DR0054149
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200020480B
—
OK
Enumeration date
02/14/2006
Last updated
12/09/2014
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