Wallace, Rafaella Izar

Wallace, Rafaella Izar is an individual health care provider with primary practice located at 500 S Henderson St Ste 200 , Fort Worth TX 76104-2154. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Gerontology, Physician Assistants & Advanced Practice Nursing Providers / Adult Health. Physician Assistants & Advanced Practice Nursing Providers / Gerontology is her primary health care specialty. Wallace, Rafaella Izar can be contacted via phone (817) 413-1500.

Contact Information

Primary practice address
500 S Henderson St Ste 200 Fort Worth TX 76104-2154
Phone: (817) 413-1500
Fax: (817) 413-1499
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X AP129253 Texas
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X AP129253 Texas

Profile Details

NPI number 1821469107
LBN Legal business name Wallace, Rafaella Izar
Credentials Adult Nurse Practitioner (ANP)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 13th, 2015
Last updated Dec 1st, 2021 - about 3 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 1821469107 NPPES
Texas MEDICAID 365509402
Texas Other 8449NZ

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