Wallace, William S

Wallace, William S is an individual health care provider with primary practice located at 1200 Peabody Ave , Memphis TN 38104-4506. He recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is his primary health care specialty. Wallace, William S can be contacted via phone (901) 272-0003.

Contact Information

Primary practice address
1200 Peabody Ave Memphis TN 38104-4506
Phone: (901) 272-0003
Fax: (901) 272-7179
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 108204 Tennessee
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X RN108204 Tennessee

Profile Details

NPI number 1457334633
LBN Legal business name Wallace, William S
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 22nd, 2005
Last updated Mar 5th, 2010 - about 14 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 1457334633 NPPES
Tennessee MEDICAID 3388963
Tennessee Other 4070262
Tennessee Other 000000028284

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