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NPI Code Detail

MEDICARE: TONIA WALLACE PMHNP-BC

MEDICARE: TONIA WALLACE PMHNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner270985AZ
2363LP0808XPsychiatric/Mental Health Nurse Practitioner5020892NC

General Provider Information

NPI Number : 1700531498
Entity Type Code : Individual
Provider Name (Legal Business Name) : TONIA WALLACE PMHNP-BC
Provider Business Mailing Address
First Line : 15652 W DURANGO ST
Second Line :
City : GOODYEAR
State : AZ
Zip : 85338-3370
Country : US
Telephone Number : 708-829-1520
Fax Number :
Provider Business Practice Location Address
First Line : 6751 N SUNSET BLVD STE 320
Second Line :
City : GLENDALE
State : AZ
Zip : 85305-3155
Country : US
Telephone Number : 480-516-8037
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2022
Last Update Date : 11/20/2025

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Directions to “ TONIA WALLACE PMHNP-BC” Practice Location

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