Individual
MRS. CHASE E WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-2526
Mailing address
3600 BROADWAY DEPT 41, OAKLAND, CA 94611-5730
(310) 542-9758
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
55368
CA
363A00000X
Physician Assistant
PA1480
ME
Other
Enumeration date
08/07/2014
Last updated
05/25/2023
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