IndividualActive
Ciji Wallace, RN-FNP
NPI 1487455036 · Family Nurse Practitioner · Bogalusa, LA
Provider details
- NPI number
- 1487455036
- Entity type
- Individual
- Primary specialty
- Family Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- RN-FNP
- Sex
- Female
- Sole proprietor
- No
- License
- 907340 (MS)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistants & Advanced Practice Nursing Providers
Nursing Service Providers
Practice location
219 S Border Dr
Bogalusa, LA 70427-3671
Phone: (985) 633-1952
Fax: (985) 732-4458
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 652
Mc Neill, MS 39457-0652
Registry dates
- Enumerated
- 2025-03-20
- Last updated
- 2025-10-14
- Certified
- 2025-10-14
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.