Wallace, Shawn Michael
Wallace, Shawn Michael is an individual health care provider with primary practice located at 2400 Unser Blvd Se Ste 08100 , Rio Rancho NM 87124. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Wallace, Shawn Michael can be contacted via phone (505) 253-6100.Contact Information
Primary practice address
2400 Unser Blvd Se Ste 08100
Rio Rancho NM 87124
Phone: (505) 253-6100
Fax: (505) 253-6186
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | PA2022-0064 | New Mexico |
Profile Details
| NPI number | 1124614706 |
|---|---|
| LBN Legal business name | Wallace, Shawn Michael |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 17th, 2020 |
| Last updated | Oct 28th, 2022 - 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1124614706 | NPPES |
| New Mexico | MEDICAID | 11783338 |
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