Individual
VICKI WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1101 SAM PERRY BLVD.,, SUITE 211, FREDERICKSBURG, VA 22401
(540) 372-7792
Mailing address
1101 SAM PERRY BLVD, SUITE 211, FREDERICKSBURG, VA 22401
(540) 372-7792
(540) 372-2073
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
RN67063
DC
363LA2100X
Acute Care Nurse Practitioner
Primary
0024166526
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036084100
—
DC
05
—
405959000
—
DC
Enumeration date
02/24/2006
Last updated
02/01/2017
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