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:
Health care specialties
Specialty | Code | License # | 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 4 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1821469107 | NPPES |
Texas | MEDICAID | 365509402 | |
Texas | Other | 8449NZ |
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