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

Justin Covey Wallace, RN

Individual provider Emergency Registered Nurse · NPI 1578807103

Justin Covey Wallace, RN is an Emergency Registered Nurse in Phoenix, Arizona. Practices as a sole proprietor. Licensed in Arizona.

Licensed in
AZ
In the registry since
2012
What do these letters mean?
RN — Registered Nurse
A licensed nurse who completed a nursing degree and passed the NCLEX-RN examination.

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Practice location Address checks out

4212 N 16th St
Phoenix, AZ 85016-5319
Phone: (602) 263-1200
Show map & directions

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

Specialties & licences

Emergency Registered Nurse (primary) Taxonomy 163WE0003X · Licence RN173423 (AZ)

Record details

NPI number1578807103
Entity typeIndividual (Type 1)
GenderMale
Credentials RN
Sole proprietorYes
NPI enumeratedNovember 20, 2012
Last updated in NPPESNovember 20, 2012

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