Individual
ASHLEY MONTAG WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3333 SILAS CREEK PKWY, WINSTON SALEM, NC 27103-3013
(336) 718-5000
Mailing address
5239 QUAIL FOREST DR, CLEMMONS, NC 27012-9984
(707) 820-9919
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
155542
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
7981
NC
Other
Enumeration date
08/15/2023
Last updated
10/10/2025
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