Wallace, Amber Michelle

Wallace, Amber Michelle is an individual health care provider with primary practice located at 615 N Michigan St 1St Fl Hospitalist Ste , South Bend IN 46601-1033. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Neonatal, which is considered as her primary health care specialty. Wallace, Amber Michelle can be contacted via phone (574) 647-3050.

Contact Information

Primary practice address
615 N Michigan St 1St Fl Hospitalist Ste South Bend IN 46601-1033
Phone: (574) 647-3050
Fax: (574) 647-1094
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Neonatal 363LN0000X 71002921A Indiana

Profile Details

NPI number 1679716534
LBN Legal business name Wallace, Amber Michelle
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 8th, 2009
Last updated Apr 28th, 2023 - about 3 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 1679716534 NPPES
Indiana MEDICAID 201017740

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