Wallace, Rebecca
Wallace, Rebecca is an individual health care provider with primary practice located at 3838 S 700 E Suite 200, Salt Lake City UT 84106-1466. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Wallace, Rebecca can be contacted via phone (801) 261-4988.Contact Information
Primary practice address
3838 S 700 E Suite 200
Salt Lake City UT 84106-1466
Phone: (801) 261-4988
Fax: (801) 269-9427
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | 216162-4405 | Utah |
Profile Details
| NPI number | 1104810134 |
|---|---|
| LBN Legal business name | Wallace, Rebecca |
| Credentials | Advanced Practice Registered Nurse (APRN) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 6th, 2005 |
| Last updated | Nov 24th, 2008 - 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1104810134 | NPPES |
| Utah | MEDICAID | D1948 |
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