Individual
ANNMARIE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
7700 FLOYD CURL DR, SAN ANTONIO, TX 78229-3902
(210) 575-4076
Mailing address
PO BOX 650426, DALLAS, TX 75265-0426
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
733121
TX
367500000X
Certified Registered Nurse Anesthetist
RN-258973
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000220486
ANTHEM BCBS INDV #
OH
01
—
100153
EMPLOYER KAISER GROUP #
OH
01
—
120766
KAISER PERMANENTE INDV #
OH
05
—
182095303
—
TX
01
—
2080224
UNITED HEALTHCARE GROUP #
OH
05
—
2274926
—
OH
01
—
34-0891295
EMPLOYER FEDERAL TAX ID #
OH
05
—
7091249
—
OH
01
—
730559
BUCKEYE COMMUNITY HLTH PL
OH
01
—
89594U
BCBS
TX
Enumeration date
05/09/2006
Last updated
03/07/2013
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