| Doctor Name: | ANN XAVIER WALLACE |
| NPI Number: | 1093809378 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NPC APRN BC |
| License Number: | 122528 |
| Business Practice Address: | 71 Walnut St Foxboro, MA - 02035 |
| Business Phone Number: | 7813411149 |
| Business Fax Number: | |
| Mailing Address: | 586 Plain St, STOUGHTON |
| State: | MA |
| Postal Code: | 02072 |
| Phone Number: | 7813411149 |
| Fax Number: | |
| NPI Enumeration Date: | 10/03/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 122528 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | MA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |