Katie Justine Wallace, FNP-BC
NPI #1790151967 in Mashpee, Massachusetts
Provider Information
- NPI Number
- 1790151967
- Entity Type
- Individual
- Name
- Katie Justine Wallace, FNP-BC
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Nurse Practitioner - Family
- Credential
- FNP-BC
- Enumeration Date
- Aug 11, 2015
- Last Updated
- Jan 4, 2016
Practice Location
- Address
- MASHPEE FAMILY MEDICINE 5 INDUSTRIAL DRIVE
- Address 2
- SUITE 100
- City
- Mashpee
- State
- Massachusetts
- ZIP Code
- 02649
- Phone
- (508) 477-4282
Specialties & Taxonomy Codes
| Specialty |
|---|
| Nurse Practitioner |
| Nurse Practitioner - Family — Family |
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