Individual
ERIN NICOLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
725 ALBANY STREET SUITE 3A, SHAPIRO BLDG., BOSTON, MA 02118
(617) 414-8052
(617) 638-8053
Mailing address
960 MASSACHUSETTS AVENUE, FL 2, BOSTON, MA 02118-2690
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA100226
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110207214A
—
MA
05
—
3145393
—
NH
Enumeration date
01/18/2024
Last updated
02/20/2026
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