Individual
MR. BENJAMIN LEVI WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
264 FM 3478 RD, HUNTSVILLE, TX 77320-3322
(936) 291-4200
Mailing address
540 PINE ST, CROCKETT, TX 75835-5555
(936) 222-1358
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP134640
TX
Other
Enumeration date
10/13/2017
Last updated
10/13/2017
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