Wallace, Nancy A

Wallace, Nancy A is an individual health care provider with primary practice located at 4800 S 109Th E Ave , Tulsa OK 74146. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as her primary health care specialty. Wallace, Nancy A can be contacted via phone (918) 742-2502.

Contact Information

Primary practice address
4800 S 109Th E Ave Tulsa OK 74146
Phone: (918) 742-2502
Fax: (918) 745-9750
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X R0031556 Oklahoma

Profile Details

NPI number 1194717249
LBN Legal business name Wallace, Nancy A
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 16th, 2005
Last updated Jul 8th, 2007 - about 17 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 1194717249 NPPES
Oklahoma Other 721545605001 BCBS
Oklahoma Other 7592237 BCBS

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