Provider Demographics
NPI:1336999408
Name:WALLACE, STEPHANIE D (DNP/FNP)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:D
Last Name:WALLACE
Suffix:
Gender:F
Credentials:DNP/FNP
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:D
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1737 GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:CA
Mailing Address - Zip Code:95938-9409
Mailing Address - Country:US
Mailing Address - Phone:530-370-3014
Mailing Address - Fax:
Practice Address - Street 1:1531 ESPLANADE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3310
Practice Address - Country:US
Practice Address - Phone:530-370-3014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029492363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily