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General NPI Number Information
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NPI Number | 1417258294
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Entity Type | Individual
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Provider Name | JOETTA DESWARTE WALLCE NP
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Gender | Female
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Dates
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Enumeration Date | 11/09/2010
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Last Update Date | 11/09/2010
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Provider Practice Location Address
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Address Line | 2653 ELM AVE SUITE 200
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City | LONG BEACH
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State | CA
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Zip | 90806-1652
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Country | US
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Telephone | 562-728-5000
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Fax | 562-595-5296
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Provider Business Mailing Address
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Address Line | 6430 W SUNSET BLVD SUITE 600
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City | LOS ANGELES
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State | CA
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Zip | 90028-7900
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Country | US
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Telephone | 323-361-2337
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Fax | 323-361-8491
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 244499
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 15928
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 787
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License Number State | CA
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