Wallace, Kristina Marie
Wallace, Kristina Marie is an individual health care provider with primary practice located at 537 Union Ave Second Floor, Grants Pass OR 97527-5543. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Wallace, Kristina Marie can be contacted via phone (541) 479-6777.Contact Information
Primary practice address
537 Union Ave Second Floor
Grants Pass OR 97527-5543
Phone: (541) 479-6777
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | PA174747 | Oregon |
Profile Details
| NPI number | 1417326984 |
|---|---|
| LBN Legal business name | Wallace, Kristina Marie |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 15th, 2015 |
| Last updated | Jun 8th, 2020 - about 6 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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