MRS. Nichole Wallace, PA is a medical physician assistant in Brooklyn, NY. MRS. Nichole Wallace, PA NPI is 1114379708. The provider is registered as an individual entity type.
The NPPES NPI record indicates the provider is a female.
The provider's business location address is:
760 BROADWAY
BROOKLYN, NY
ZIP 11206-317
Phone: (718) 312-2312
The NPI 1114379708 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.
The enumeration date for this NPI number is 7/6/2016 and was last updated on 8/18/2023.