Heather E Wallace
Nurse Practitioner Nurse Practitioner - Gerontology
535 Coliseum Dr
Macon
, Georgia 31217-0104
Heather E Wallace
Nurse Practitioner Nurse Practitioner - Gerontology
535 Coliseum Dr
Macon
, Georgia 31217-0104
(478) 972-0277
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About
Features
Specialties
- Nurse Practitioner
- Nurse Practitioner - Gerontology
Languages spoken
- English
Location
First Address
- Heather E Wallace
- Po Box 26698
- Macon, GA
- Zip : 31221-6698
- Phone : (478) 972-0277
Second Address
- Heather E Wallace
- 535 Coliseum Dr
- Macon, GA
- Zip : 31217-0104
- Phone : (478) 972-0277
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FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | RN197918 | GA |
| Y | 363LG0600X | Nurse Practitioner - Gerontology | RN197918 | GA |
National Provider Identifier
| NPI | 1053856427 |
|---|---|
| Provider Name | Heather E Wallace |
| First Address | Macon, GA 31221-6698 |
| Second Address | Macon, GA 31217-0104 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 21/12/2016 |
| Last Update Date | 27/12/2016 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.