Most Relevant Information
Provider Data
| NPI Number: | 1003541095 |
| Provider Name: | IMELDA V WALLACE FNP-BC |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 2022000137 |
Most Important Dates
| Enumeration Date: | 07/22/2022 |
| Last Updated: | 07/22/2022 |
Provider Practice Location
11860 VISTA DEL SOL DR STE 150
EL PASO
TX
799366128
Practice Location Phone/Fax
| Phone: | 9158084000 |
| Fax: |
Provider Mailing Location
11860 VISTA DEL SOL DR STE 150
EL PASO
TX
799366128
Provider Mailing Phone/Fax
| Phone: | 9158084000 |
| Fax: |