Healthcare Provider Details

I. General information

NPI: 1922244805
Provider Name (Legal Business Name): CHRISTINE D WALLACE AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE D SCHMELING AU.D.

II. Dates (important events)

Enumeration Date: 12/26/2008
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 2ND ST S
NAMPA ID
83651-3708
US

IV. Provider business mailing address

PO BOX 1100
BOISE ID
83701-1100
US

V. Phone/Fax

Practice location:
  • Phone: 208-385-3620
  • Fax: 208-386-3621
Mailing address:
  • Phone: 208-489-4690
  • Fax: 208-489-4072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD-1246
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number21617
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD1246
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: