Nikki L Wallace, CRNA
Nurse Anesthetist, Certified Registered in Nashville, TN. Individual provider (NPI-1).
NPI number1104875459
StatusActive
Last updated in NPPESMar 17, 2018
Details
- NPI
- 1104875459
- Entity type
- Individual (NPI-1)
- Name
- Nikki L Wallace
- Credential
- CRNA
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 6, 2006
- Last updated
- Mar 17, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 9725 | TN | Yes |
Practice location
110 29th Ave N Ste 202Nashville, TN 37203-1448
Phone 615-327-4304
Mailing address
110 29th Ave N Ste 202Nashville, TN 37203-1448
Phone 615-327-4304
Other practice locations
400 E Tickle St
Dyersburg, TN 38024-3120
Dyersburg, TN 38024-3120
Phone 731-285-2410
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