Provider Demographics
NPI:1699587592
Name:WALLACE, KRISTEN MEREDITH (CNM)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MEREDITH
Last Name:WALLACE
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Gender:
Credentials:CNM
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Mailing Address - Street 1:111 CHAMBERS HILL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-7304
Mailing Address - Country:US
Mailing Address - Phone:717-709-7922
Mailing Address - Fax:717-263-2055
Practice Address - Street 1:830 5TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4224
Practice Address - Country:US
Practice Address - Phone:717-709-7990
Practice Address - Fax:717-709-7991
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-05-05
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Provider Licenses
StateLicense IDTaxonomies
PAMW010856367A00000X
PASP032760363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health