SHAWN MICHAEL WALLACE

RIO RANCHO, NM
NPI1124614706
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: NM  PA2022-0064)
Enumeration Date2020-12-17
Last Update Date2022-10-28
Business Address
Mr. SHAWN MICHAEL WALLACE PA-C
2400 UNSER BLVD SE STE 08100
RIO RANCHO, NM 87124
Phone number: 505-253-6100
Mailing Address
Mr. SHAWN MICHAEL WALLACE PA-C
PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE, NM 87125-6666
Phone number: 505-923-6770
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