Provider Demographics
NPI:1760986558
Name:WALLACE, MARY MEAGHAN (NP)
Entity Type:Individual
Prefix:
First Name:MARY MEAGHAN
Middle Name:
Last Name:WALLACE
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:6624 FANNIN ST STE 2380
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2308
Mailing Address - Country:US
Mailing Address - Phone:713-800-6212
Mailing Address - Fax:713-800-6241
Practice Address - Street 1:1900 S JACKSON RD STE 1
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1589
Practice Address - Country:US
Practice Address - Phone:956-340-4222
Practice Address - Fax:956-307-3234
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2021-08-25
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Provider Licenses
StateLicense IDTaxonomies
TX822658163W00000X
TXAP134629363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse