Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MARY WALLACE
ActiveMARY WALLACE is a Child & Adolescent Psychiatric Nurse healthcare provider located in HALF MOON BAY, California. NPI 1639297021 is currently active in the NPPES registry. Verify at CMS.
Child & Adolescent Psychiatric Nurse · HALF MOON BAY, CA
Registration Details
- NPI Number
- 1639297021
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Mar 26, 2007 (19.205787694895 yrs)
- Last Updated
- Sep 11, 2025
- Licenses
-
MFC31243 (CA)219605 (CA)
Practice Information
- Address
-
225 CABRILLO HWY SSUITE 200AHALF MOON BAY, CA, 940198200Browse CA providers · Browse ZIP 94019
- Phone
- 6505733724
- Fax
- 6507264963
- Primary Specialty
-
Child & Adolescent Psychiatric Nurse
163WP0808X
- Additional Specialty
- Child & Adolescent Psychiatric Nurse
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.