Individual
SUSANNAH WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1500 MISSION ST, SAN FRANCISCO, CA 94103-2513
(646) 650-5337
(646) 871-6820
Mailing address
1449 FAIRBANKS ST SW, ATLANTA, GA 30310-4349
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
95029800
CA
Other
Enumeration date
12/06/2021
Last updated
03/27/2025
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