Individual
PEGGY LYNN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
2132 N 1700 W, STE 100, LAYTON, UT 84041-7059
(801) 807-7900
(801) 807-7904
Mailing address
1115 E 1675 N, NORTH OGDEN, UT 84404-3379
(801) 675-6624
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
114266-4405
UT
Other
Enumeration date
07/15/2021
Last updated
06/27/2023
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