person
Ms. Micah R Wallace, PA-C
Surgical Physician Assistant in Latrobe, Pennsylvania
NPI 1588946214

Micah R Wallace is a Surgical Physician Assistant based in Jeannette, PA and is specialized in Surgical. Micah R Wallace practices in Latrobe, PA and has the professional credentials of PA-C. The NPI Number for Micah R Wallace is 1588946214 and holds a License No. MA054581 (Pennsylvania).

The current practice location address for Micah R Wallace is 100 Excela Health Dr Ste 102, Latrobe, PA and can be reached out via phone at 724-804-1760 and via fax at 724-804-1762.

Location: 100 Excela Health Dr Ste 102, Latrobe, PA, 15644-2538
person
Provider Profile Details
NPI Number
1588946214
Provider Name
Micah R Wallace
Credential
PA-C
Provider Entity Type
Individual
Gender
Female
Address
100 Excela Health Dr Ste 102, Latrobe, PA, 15644-2538
Phone Number
724-804-1760
Fax Number
724-804-1762
Provider Enumeration Date
09/20/2011
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
103167119 05 PA
institution
Provider Business Practice Location Address Details
Address
100 Excela Health Dr Ste 102
City
State
Zip
15650-9001
Phone Number
724-804-1760
Fax Number
724-804-1762
person
Provider Business Mailing Address Details
Address
100 Excela Health Dr Ste 102
City
State
Zip
15650-9001
Phone Number
724-804-1760
Fax Number
724-804-1762
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Surgical
Taxonomy
License No.
MA054581 (Pennsylvania)
Definition
Definition to come...
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