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

Holly A Wallace, APNP

Individual provider Nurse Practitioner · NPI 1124660592

Holly A Wallace, APNP is a Nurse Practitioner in Summit, Wisconsin. Qualified in 2019, 7 years ago. Practices with Watertown Family Practice Associates, SC, a 10-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Wisconsin.

Years since qualifying
7
Licensed in
WI
In the registry since
2019
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Practice location Address checks out

36500 Aurora Dr
Summit, WI 53066-4899
Phone: (262) 434-1000
Fax: (262) 434-5050
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2428 N Grandview Blvd Ste 102, Waukesha, WI 53188-6906 — (262) 875-5070

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 9679 (WI)

Record details

NPI number1124660592
Entity typeIndividual (Type 1)
GenderFemale
Credentials APNP
Sole proprietorNo
NPI enumeratedOctober 17, 2019
Last updated in NPPESOctober 24, 2025
Certification dateOctober 24, 2025
Mailing addressPo Box 735044, Chicago, IL 60673-5044

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Watertown Family Practice Associates, Sc — 10 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

Other providers in Summit