Miata Wallace, PA

NPI #1013656990 in Lincoln, Nebraska

Provider Information

NPI Number: 1013656990
Entity Type: Individual
Name: Miata Wallace, PA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA
Enumeration Date: May 31, 2022
Last Updated: Mar 25, 2025

Practice Location

Address: 1500 S 58TH ST STE 800
City: Lincoln
State: Nebraska
ZIP Code: 68506-1407
Phone: (402) 483-8600

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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