| Doctor Name: | AUGIE WALLACE |
| NPI Number: | 1083083455 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 28613601 |
| Business Practice Address: | 4312 Main St Apt 316 Philadelphia, PA - 191271531 |
| Business Phone Number: | 4844338208 |
| Business Fax Number: | |
| Mailing Address: | 4312 Main St Apt 316, PHILADELPHIA |
| State: | PA |
| Postal Code: | 191271531 |
| Phone Number: | 4844338208 |
| Fax Number: | |
| NPI Enumeration Date: | 09/16/2015 |
| NPI Last Update Date: | 09/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 374U00000X |
| License Number: | 28613601 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Nursing Service Related Providers |
| Taxonomy Classification: | Home Health Aide |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A person trained to assist public health nurses, home health nurses, and other health professionals in the bedside care of patients in their homes. |