Provider Demographics
NPI:1396198255
Name:WALLACE, ALEXIS (DVM)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:
Last Name:WALLACE
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2723 PAOLI PIKE
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-5115
Mailing Address - Country:US
Mailing Address - Phone:812-945-0423
Mailing Address - Fax:
Practice Address - Street 1:2723 PAOLI PIKE
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-5115
Practice Address - Country:US
Practice Address - Phone:812-945-0423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN24005203174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist