Provider Demographics
NPI:1366746364
Name:WALLIS, MARGARET VIRGINIA (FACCE, LCCE, BSS)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:VIRGINIA
Last Name:WALLIS
Suffix:
Gender:F
Credentials:FACCE, LCCE, BSS
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:VIRGINIA
Other - Last Name:WALLIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LM, CPM
Mailing Address - Street 1:9509 PRESTHOPE DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-5768
Mailing Address - Country:US
Mailing Address - Phone:972-977-1707
Mailing Address - Fax:
Practice Address - Street 1:9509 PRESTHOPE DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-5768
Practice Address - Country:US
Practice Address - Phone:972-977-1707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174H00000X
374J00000X
TX99262176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174H00000XOther Service ProvidersHealth Educator
No374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX99262OtherMIDWIFE