Laurie J Wallace, RPA-C

NPI #1326261579 in Miller Place, New York

Provider Information

NPI Number: 1326261579
Entity Type: Individual
Name: Laurie J Wallace, RPA-C
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physician Assistant
Credential: RPA-C
Enumeration Date: Apr 10, 2007
Last Updated: Nov 10, 2021

Practice Location

Address: 765 ROUTE 25A STE 6
City: Miller Place
State: New York
ZIP Code: 11764-2649
Phone: (631) 320-3200

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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