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General NPI Number Information
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NPI Number | 1790725075
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Entity Type | Individual
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Provider Name | MARY WALLACE HOWELL PAC FNP
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Gender | Female
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 2330 W COVELL BLVD STE 100
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City | DAVIS
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State | CA
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Zip | 95616
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Country | US
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Telephone | 530-668-2660
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Fax | 530-756-5817
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Provider Business Mailing Address
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Address Line | 632 W GIBSON RD
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City | WOODLAND
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State | CA
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Zip | 95695-5169
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Country | US
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Telephone | 530-666-1631
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP8902
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA14001
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License Number State | CA
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