Individual
ALEXANDREA IRENE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, APRN, PMHNP-BC
Contact information
Practice address
4241 E PIEDRAS DR STE 118, SAN ANTONIO, TX 78228-1422
(210) 301-0031
(210) 301-0031
Mailing address
85 NE LOOP 410 STE 315, SAN ANTONIO, TX 78216-5836
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1104891
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1952164063
NPPES
—
Enumeration date
12/29/2022
Last updated
11/13/2024
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