Wallace, Jesse Lee

Wallace, Jesse Lee is an sole proprietor health care provider with primary practice located at 1215 Lee St , Charlottesville VA 22908-0816. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Critical Care Medicine, which is considered as his primary health care specialty. Wallace, Jesse Lee can be contacted via phone (434) 924-3627.

Contact Information

Primary practice address
1215 Lee St Charlottesville VA 22908-0816
Phone: (434) 924-3627
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Critical Care Medicine 363LC0200X 0024187479 Virginia

Profile Details

NPI number 1013697267
LBN Legal business name Wallace, Jesse Lee
Credentials RN, APRN
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 24th, 2023
Last updated Jul 24th, 2023 - 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 1013697267 NPPES
Other NONE NONE

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