Wallace, Jennifer Katherine

Wallace, Jennifer Katherine is an individual health care provider with primary practice located at 2660 E Main St Suite 204, Ventura CA 93003-2893. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Wallace, Jennifer Katherine can be contacted via phone (805) 643-7500.

Contact Information

Primary practice address
2660 E Main St Suite 204 Ventura CA 93003-2893
Phone: (805) 643-7500
Fax: (805) 643-7501
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA20925 California

Profile Details

NPI number 1578796926
LBN Legal business name Wallace, Jennifer Katherine
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 2nd, 2009
Last updated Sep 8th, 2010 - about 15 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 1578796926 NPPES
Colorado Other 2826 PHYSICIAN ASSISTANT LICENSE
Colorado Other PA20925 PHYSICIAN ASSISTANT LICENSE

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