Wallace, Jessica Elizabeth

Wallace, Jessica Elizabeth is an individual health care provider with primary practice located at 2200 N Sepulveda Blvd , Manhattan Beach CA 90266-2910. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Family. Nursing Service Providers / Registered Nurse is her primary health care specialty. Wallace, Jessica Elizabeth can be contacted via phone (310) 802-0200.

Contact Information

Primary practice address
2200 N Sepulveda Blvd Manhattan Beach CA 90266-2910
Phone: (310) 802-0200
Fax: (310) 794-9035
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 547962 California
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 10241 California

Profile Details

NPI number 1215981170
LBN Legal business name Wallace, Jessica Elizabeth
Credentials NURSE PRACTITIONER
Entity Individual
Sole proprietor 1 No
Enumeration date May 22nd, 2006
Last updated Dec 19th, 2019 - about 7 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 1215981170 NPPES
California Other RN547962 MEDICAL

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