Madeline Wallace, PA-C Valid NPI

Individual provider · Physician Assistant · Evans, CO

NPI

1649854456

Type

Individual (Type 1)

Primary specialty

Physician Assistant

Specialty group

Physician Assistants & Advanced Practice Nursing Providers

Taxonomy code

363A00000X

License number

6761 (CO)

Sex

Female

Sole proprietor

No

Enumerated

2021-05-07

Last updated

2021-06-29