Search › Nebraska › 363A00000X
Miata Wallace, PA
NPI 1013656990 · on the registry since 2022
Practice
- Address
- 1500 S 58th St Ste 800
Lincoln, NE 68506 - Phone
- (402) 483-8600
- Fax
- (402) 483-8689
Registry record
- Primary taxonomy
- 363A00000X
363A00000X
- Licence states on file
- NE
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2025-03-25
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Nebraska