Wallace, Nichole G

Wallace, Nichole G is an individual health care provider with primary practice located at 13123 E 16Th Ave B390, Aurora CO 80045-7106. She recently has only one registered license in Allopathic & Osteopathic Physicians / Child Abuse Pediatrics, which is considered as her primary health care specialty. Wallace, Nichole G can be contacted via phone (303) 864-5250.

Contact Information

Primary practice address
13123 E 16Th Ave B390 Aurora CO 80045-7106
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Child Abuse Pediatrics 2080C0008X DR0054149 Colorado

Profile Details

NPI number 1497729909
LBN Legal business name Wallace, Nichole G
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 14th, 2006
Last updated Dec 9th, 2014 - about 10 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 1497729909 NPPES
Oklahoma MEDICAID 200020480B

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