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

MS. Bonnie Merritt Wallace, PA-C

Individual provider Physician Assistant · NPI 1437402229

MS. Bonnie Merritt Wallace, PA-C is a Physician Assistant in Portage, Michigan. Licensed in Michigan. Registered with an NPI since 2012.

Licensed in
MI
In the registry since
2012
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

3304 Cooley Ct
Portage, MI 49024-7430
Phone: (269) 349-2266
Fax: (269) 349-0792
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5601006513 (MI)

Record details

NPI number1437402229
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedOctober 18, 2012
Last updated in NPPESOctober 12, 2014

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