Wallace, Connie Sue

Wallace, Connie Sue is an individual health care provider with primary practice located at 10030 Gilead Rd Ste 201 , Huntersville NC 28078-7545. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Wallace, Connie Sue can be contacted via phone (704) 887-4530.

Contact Information

Primary practice address
10030 Gilead Rd Ste 201 Huntersville NC 28078-7545
Phone: (704) 887-4530
Fax: (704) 887-4531
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 102472 North Carolina
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 102472 North Carolina

Profile Details

NPI number 1619179132
LBN Legal business name Wallace, Connie Sue
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 5th, 2007
Last updated Aug 23rd, 2022 - about 2 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 1619179132 NPPES
North Carolina Other 2747736E MEDICARE PTAN
North Carolina MEDICAID 8101076 MEDICARE PTAN
North Carolina Other 159XJ MEDICARE PTAN

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