Wallace, Brian

Wallace, Brian is an individual health care provider with primary practice located at 1910 Roseland Blvd , Tyler TX 75701-4246. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Primary Care, which is considered as his primary health care specialty. Wallace, Brian can be contacted via phone (903) 533-0644.

Contact Information

Primary practice address
1910 Roseland Blvd Tyler TX 75701-4246
Phone: (903) 533-0644
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Primary Care 363LP2300X RN 169685C Colorado

Profile Details

NPI number 1457561615
LBN Legal business name Wallace, Brian
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date May 23rd, 2007
Last updated Mar 12th, 2010 - about 14 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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