Individual
MS. PAULA M. WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
312 GRAMMONT ST STE 401, MONROE, LA 71201-7403
(318) 966-1809
(318) 966-1810
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(318) 323-1809
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
P.A.A10590.RX
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1429112
—
LA
Enumeration date
07/26/2006
Last updated
01/13/2026
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