Wallace, Vicki

Wallace, Vicki is an individual health care provider with primary practice located at 1101 Sam Perry Blvd., Suite 211, Fredericksburg VA 22401. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Acute Care. Physician Assistants & Advanced Practice Nursing Providers / Acute Care is her primary health care specialty. Wallace, Vicki can be contacted via phone (540) 372-7792.

Contact Information

Primary practice address
1101 Sam Perry Blvd., Suite 211 Fredericksburg VA 22401
Phone: (540) 372-7792
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X RN67063 District of Columbia
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X 0024166526 Virginia

Profile Details

NPI number 1689640195
LBN Legal business name Wallace, Vicki
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 24th, 2006
Last updated Feb 1st, 2017 - about 8 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 1689640195 NPPES
District of Columbia MEDICAID 036084100
District of Columbia MEDICAID 405959000

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