Jerrol B Wallace CRNA

NPI 1316084932 - Nurse Anesthetist, Certified Registered - 367500000X

NPI Details
NPI 1316084932
Gender Male
Enumeration Date 01/31/2007
Last Updated 04/17/2008
Entity Type Individual
Active Over 9 years ago
Practice Location
620 JOHN PAUL JONES CIR
ANESTHESIA DEPARTMENT NMC PORTSMOUTH
PORTSMOUTH VA, 23708-2111, US
Phone (757) 953-3238
Fax
Business Location
1608 REVELLA ARCH
CHESAPEAKE VA, 23322-6991, US
Phone (619) 823-7845
Fax
Toxanomy
Taxonomy Code 367500000X
License State Virginia
License Number 0024167758
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According to our database, Mr. Jerrol B Wallace CRNA NPI is 1316084932, taxonomy code is 367500000X and license number is 0024167758, license state is located at Virginia. Jerrol B Wallace CRNA physically located at 620 John Paul Jones Cir, Portsmouth VA, 23708-2111. NPI Number Jerrol B Wallace CRNA has the Individual type.

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1316084932 NPI number is provided on an as is basis without warranty of any kind. 1316084932 is maintained by the National Plan & Provider Enumeration System. The contents of Jerrol B Wallace CRNA are for informational purposes only.