Wallace, Jamie Russelle

Wallace, Jamie Russelle is an individual health care provider with primary practice located at 10752 N 89Th Pl #126, Scottsdale AZ 85260. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Wallace, Jamie Russelle can be contacted via phone (480) 860-1161.

Contact Information

Primary practice address
10752 N 89Th Pl #126 Scottsdale AZ 85260
Phone: (480) 860-1161
Fax: (480) 860-6561
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 12810 Arizona

Profile Details

NPI number 1023066354
LBN Legal business name Wallace, Jamie Russelle
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 5th, 2006
Last updated Jul 21st, 2022 - about 4 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 1023066354 NPPES
Arizona MEDICAID 226143-001

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