Individual
ALEXIA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
221 E HUNDRED RD, CHESTER, VA 23836-2613
(804) 530-1172
Mailing address
221 E HUNDRED RD, CHESTER, VA 23836-2613
(804) 530-1172
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024174328
VA
363LF0000X
Family Nurse Practitioner
9287652
FL
Other
Enumeration date
01/28/2016
Last updated
03/01/2017
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