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General NPI Number Information
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NPI Number | 1245673565
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Entity Type | Individual
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Provider Name | TRESA C WALLACE WHNP
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Gender | Female
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Dates
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Enumeration Date | 04/17/2013
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Last Update Date | 11/22/2025
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Provider Practice Location Address
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Address Line | 201 N ILLINOIS ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-1904
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Country | US
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Telephone | 888-731-8994
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 CANAL ST
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City | NEW ORLEANS
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State | LA
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Zip | 70112-3018
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Country | US
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Telephone | 504-702-3928
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | AP07277
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License Number State | LA
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