MS. Bonnie Merritt Wallace, PA-C

NPI #1437402229 in Portage, Michigan

Provider Information

NPI Number: 1437402229
Entity Type: Individual
Name: MS. Bonnie Merritt Wallace, PA-C
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Oct 18, 2012
Last Updated: Oct 12, 2014

Practice Location

Address: 3304 COOLEY CT
City: Portage
State: Michigan
ZIP Code: 49024-7430
Phone: (269) 349-2266

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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