Most Relevant Information
Provider Data
| NPI Number: | 1003414228 |
| Provider Name: | CHELSEA ROSE WALLACE RN, FNP-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363L00000X |
| Specialty: | Nurse Practitioner |
| License Number: | 57758 |
Most Important Dates
| Enumeration Date: | 10/09/2020 |
| Last Updated: | 10/09/2020 |
Provider Practice Location
9976 W EMERALD ST
BOISE
ID
837049769
Practice Location Phone/Fax
| Phone: | 2082293742 |
| Fax: |
Provider Mailing Location
9976 W EMERALD ST
BOISE
ID
837049769
Provider Mailing Phone/Fax
| Phone: | 2082293742 |
| Fax: |