Wallace, Lisa M

Wallace, Lisa M is an individual health care provider with primary practice located at 2525 W University Ave Ste 300 , Muncie IN 47303-3432. She recently has 3 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Adult Health, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Oncology. Physician Assistants & Advanced Practice Nursing Providers / Adult Health is her primary health care specialty. Wallace, Lisa M can be contacted via phone (765) 289-5420.

Contact Information

Primary practice address
2525 W University Ave Ste 300 Muncie IN 47303-3432
Phone: (765) 289-5420
Fax: (765) 281-2065
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 71003281A Indiana
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 71003281A Indiana
Physician Assistants & Advanced Practice Nursing Providers / Oncology 364SX0200X 71003281A Indiana

Profile Details

NPI number 1134438286
LBN Legal business name Wallace, Lisa M
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 6th, 2010
Last updated Apr 6th, 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 1134438286 NPPES
Indiana MEDICAID 201000070
Indiana Other 00000932255

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