Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Hattie Wallace

Individual provider Licensed Practical Nurse · NPI 1164796520

Hattie Wallace is a Licensed Practical Nurse in Phoenix, Arizona. Practices as a sole proprietor. Licensed in Arizona.

Licensed in
AZ
In the registry since
2012

Practice location Address checks out

14625 S Mountain Pkwy Apt 1056
Phoenix, AZ 85044-7142
Phone: (602) 565-2159
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Licensed Practical Nurse (primary) Taxonomy 164W00000X · Licence LP044351 (AZ)

Record details

NPI number1164796520
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedMarch 2, 2012
Last updated in NPPESMarch 2, 2012
Mailing address14625 S Mountain Pkwy, Apt 1056, Phoenix, AZ 85044-7142

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