Individual
CAROL A WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4800 SAND POINT WAY NE, SEATTLE, WA 98105-3901
(206) 987-2000
Mailing address
4500 SAND POINT WAY NE, #100, SEATTLE, WA 98105-3900
Taxonomy
Speciality
Code
Description
License number
State
2080P0216X
Pediatric Rheumatology Physician
Primary
MD00014380
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1524107
—
WA
01
—
6570
INTERNAL ID-MOTOR VEHICLE ID
—
Enumeration date
10/17/2006
Last updated
06/08/2015
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