Provider Demographics
NPI:1518005248
Name:WALLACE, JULIANN MARIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:JULIANN
Middle Name:MARIA
Last Name:WALLACE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11391 S VIEWPOINTE WAY
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85367-6811
Mailing Address - Country:US
Mailing Address - Phone:928-342-7374
Mailing Address - Fax:
Practice Address - Street 1:840 E 22ND ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-2425
Practice Address - Country:US
Practice Address - Phone:928-782-9241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN143698163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool