Search › Arizona › 164W00000X
Hattie Wallace
NPI 1164796520 · on the registry since 2012 · sole proprietor
Practice
- Address
- 14625 S Mountain Pkwy
Apt 1056
Phoenix, AZ 85044 - Phone
- (602) 565-2159
- Clinicians at this address
- 2
Registry record
- Primary taxonomy
- 164W00000X
164W00000X
- Licence states on file
- AZ
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2012-03-02
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 Arizona