Andrea Nicole Wallace, FNP
Nurse Practitioner, Family in Charlotte, NC. Individual provider (NPI-1).
NPI number1417455809
StatusActive
Last updated in NPPESJul 15, 2024
Details
- NPI
- 1417455809
- Entity type
- Individual (NPI-1)
- Name
- Andrea Nicole Wallace
- Credential
- FNP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jan 31, 2018
- Last updated
- Jul 15, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 5010264 | NC | Yes |
| 363L00000X | Nurse Practitioner | 5010264 | NC |
Practice location
14214 Ballantyne Lake RdSte 100
Charlotte, NC 28277-3372
Phone 704-667-2650
Mailing address
Po Box 19305Charlotte, NC 28219-9305
Other practice locations
5717 Albemarle Rd
Charlotte, NC 28212-1634
Charlotte, NC 28212-1634
Phone 704-563-2150
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