Madeline Wallace, PA-C

Physician Assistant · Evans, CO

Individual Active NPI

NPI number 1649854456

Practice location

2930 11TH Ave
Evans, CO 80620-1011
Phone
(970) 353-9403

Open in Google Maps

NPI record

NPI
1649854456
Entity type
Individual (Type 1)
Enumeration date
May 7, 2021
Last updated
June 29, 2021
Certified
June 29, 2021
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Physician Assistant Primary 363A00000X 6761 CO

About Madeline Wallace

Madeline Wallace, PA-C is a healthcare provider registered in the NPI registry with the primary taxonomy Physician Assistant (code 363A00000X). The practice location is 2930 11TH Ave, Evans, CO 80620-1011. The NPI number 1649854456 was assigned on May 7, 2021 and the record was last updated on June 29, 2021.

Madeline Wallace lists a license in the registry: #6761 (CO) for Physician Assistant. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Madeline Wallace, PA-C?

The NPI number is 1649854456.

What is the phone number of Madeline Wallace?

The phone number listed for the practice location is (970) 353-9403.

Where is Madeline Wallace located?

2930 11TH Ave, Evans, CO 80620-1011.

What is the taxonomy code for Madeline Wallace?

The primary taxonomy code is 363A00000X – Physician Assistant.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

Other Physician Assistant providers in Evans

All Physician Assistant providers in Evans, CO →