Wallace, Bernice E

Wallace, Bernice E is an individual health care provider with primary practice located at 4101 Nw 4Th St Suite 200, Plantation FL 33317-2850. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Wallace, Bernice E can be contacted via phone (954) 791-5420.

Contact Information

Primary practice address
4101 Nw 4Th St Suite 200 Plantation FL 33317-2850
Phone: (954) 791-5420
Fax: (954) 791-5950
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X ARNP1772012 Florida

Profile Details

NPI number 1679887707
LBN Legal business name Wallace, Bernice E
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 30th, 2010
Last updated Feb 16th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679887707 NPPES
Florida MEDICAID 302604300

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