Wallace, Tamara

Wallace, Tamara is an individual health care provider with primary practice located at 1401 S Seward Meridian Pkwy Ste Abc , Wasilla AK 99654-8312. She recently has only one registered license in Nursing Service Related Providers / Day Training/Habilitation Specialist, which is considered as her primary health care specialty. Wallace, Tamara can be contacted via phone (907) 631-3520.

Contact Information

Primary practice address
1401 S Seward Meridian Pkwy Ste Abc Wasilla AK 99654-8312
Phone: (907) 631-3520
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Related Providers / Day Training/Habilitation Specialist 373H00000X

Profile Details

NPI number 1205471232
LBN Legal business name Wallace, Tamara
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 13th, 2019
Last updated Nov 13th, 2019 - about 5 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 1205471232 NPPES
Alaska MEDICAID 123456789

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