Individual
ANYA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
309 S SHARON AMITY RD., SUITE 206, CHARLOTTE, NC 28211
(704) 360-5018
(980) 273-1102
Mailing address
309 S SHARON AMITY RD., SUITE 206, CHARLOTTE, NC 28211
(704) 360-5018
(980) 273-1102
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-05473
NC
363AM0700X
Medical Physician Assistant
Primary
0010-05473
NC
Other
Enumeration date
01/05/2015
Last updated
07/14/2021
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