NPI 1003057852

Michael Alan Wallace, CNP

Practitioner Family Nurse Practitioner Albuquerque, NM

Practice location

Address: 8210 Louisiana Blvd NE Suite C, Albuquerque, NM 87113-1761
Phone: (505) 858-1222
Fax: (505) 858-1224

Registered specialties

Family Nurse Practitioner Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363LF0000X Licence R48828 (NM)

Other Nurse Practitioner providers in New Mexico →

Registry record

NPI: 1003057852
Entity type: Individual
Sex (as registered): Male
NPI issued: 7 Mar 2009
Record last updated: 11 Mar 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.