Provider Demographics
NPI:1548410863
Name:WALLACE, ASHLEY SMITH (NP-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:SMITH
Last Name:WALLACE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DUKE UNIVERSITY HOSPITAL SOUTH CLINIC 2D
Mailing Address - Street 2:PO BOX 3094 MED CTR
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-681-4224
Mailing Address - Fax:
Practice Address - Street 1:DUKE UNIVERSITY HOSPITAL SOUTH
Practice Address - Street 2:200 TRENT DRIVE-CLINIC 2D
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-681-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004117363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily