Provider Demographics
NPI:1386059061
Name:WALLACE, NATALIE HALE (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:HALE
Last Name:WALLACE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:NATALIE
Other - Middle Name:ADELE
Other - Last Name:HALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:2925 DEBARR RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2974
Mailing Address - Country:US
Mailing Address - Phone:907-279-3155
Mailing Address - Fax:907-279-3154
Practice Address - Street 1:2925 DEBARR RD STE 300
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2974
Practice Address - Country:US
Practice Address - Phone:907-279-3155
Practice Address - Fax:907-279-3154
Is Sole Proprietor?:No
Enumeration Date:2014-06-21
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK159302207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology