Individual
LA TANYA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
6921 SPERRY CT, SAN DIEGO, CA 92111-7030
(858) 717-0164
(888) 425-0508
Mailing address
6921 SPERRY CT, SAN DIEGO, CA 92111-7030
(858) 717-0164
(888) 425-0508
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
680663
CA
363L00000X
Nurse Practitioner
22485
CA
363LF0000X
Family Nurse Practitioner
22485
CA
363LF0000X
Family Nurse Practitioner
680663
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
22485
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22485
BOARD OF REGISTERED NURSING
CA
01
—
680663
CA BRN
CA
Enumeration date
07/03/2008
Last updated
01/28/2024
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us