Individual
SUZANNE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
500 UNIVERSITY DR, HERSHEY, PA 17033-2360
(800) 233-4082
Mailing address
PO BOX 858, HERSHEY, PA 17033-0858
(800) 233-4082
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
SP009450
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SP009450
MEDICAL LICENSE
PA
Enumeration date
01/18/2008
Last updated
12/10/2009
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