LISA M WALLACE (NPI# 1134438286) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134438286 |
| Entity Type | Individual |
| Full Name | LISA M WALLACE |
| Other Name | LISA M RICHWINE |
| Credential | NP |
| Practice Address |
831 N Theatre Drive Marion IN 46952-1701 |
| Mailing Address |
330 N Wabash Ste G20 Marion IN 46952-2600 |
| Practice Telephone | 7656607800 |
| Practice Fax Number | 7656624470 |
| Mailing Telephone | 7656607600 |
| Mailing Fax Number | 7656517313 |
| Enumeration Date | 2010-10-06 |
| Last Update Date | 2020-10-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | 71003281A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
71003281A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 201000070 | 05 | |
| IN | ANTHEM | 00000932255 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396368064 | Lisa Jean Wallace | Occupational Therapy Assistant | 480 Somerset St Unit 1, North Plainfield, NJ 07060-4018 | 2020-05-28 |
| 1336779925 | Lisa Wallace | Counselor | 2769 Iris Ave Ste 107, Boulder, CO 80304-4405 | 2020-01-22 |
| 1710521968 | Lisa Anne Wallace | Counselor | 418 Barr Rd, Lexington, SC 29072-2363 | 2019-10-31 |
| 1598225930 | Lisa Buckner Wallace | Counselor | 3750 N Center St, Hickory, NC 28601-8089 | 2019-03-21 |
| 1235637182 | Lisa M. Wallace | Nurse Practitioner | 800 E Cheves St Ste 200, Florence, SC 29506-2651 | 2018-01-25 |
| 1134575475 | Lisa Wallace | Counselor | 14 Farmer Rd, Milton, MA 02186-3743 | 2016-05-05 |
| 1720476641 | Lisa Wallace | Registered Nurse | 7601 Hospital Dr Ste 202, Sacramento, CA 95823-5408 | 2014-12-30 |
| 1124002571 | Lisa M Wallace | Counselor | 1807 Capitol Ave, Suite 101 A, Cheyenne, WY 82001-4544 | 2005-11-30 |
| 1003423658 | Lisa Carol Wallace | Nurse Practitioner | 2418 180th St, Allerton, IA 50008-8715 | 2020-09-28 |
| 1992368872 | Lisa Wallace | Licensed Practical Nurse | 27777 Inkster Rd, Farmington Hills, MI 48334-5326 | 2019-04-17 |
| Street Address |
831 N THEATRE DRIVE |
| City | MARION |
| State | IN |
| Zip Code | 46952-1701 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982245874 | John Robert Searfoss Sr. | Counselor | 314 S Norton Ave., Marion, IN 46952 | 2019-10-02 |
| 1063069755 | Andrea Marie Brown | Behavior Technician | 2315 W 2nd St, Marion, IN 46952 | 2019-08-19 |
| 1548767767 | Johnnie Micheal Hiles | Counselor | 315 South Norton Ave., Marion, IN 46952 | 2018-04-13 |
| 1669979936 | Sheila Ann Johnson | Counselor | 315 S. Norton Ave, Marion, IN 46952 | 2018-04-12 |
| 1679070957 | Marissa Lynn Castillo | Counselor | 315 S Norton Avenue, Marion, IN 46952 | 2018-04-12 |
| 1326545609 | Eumalla Lampkins | Case Manager/Care Coordinator | 315 South Norton Avenue, Marion, IN 46952 | 2018-04-12 |
| 1285011650 | Forefront Dermatology, S.c. | Dermatology | 330 N Wabash Ave Ste 360, Marion, IN 46952 | 2015-05-05 |
| 1649510959 | Cancer Services of Grant County Inc. | Prosthetic/Orthotic Supplier | 305 S. Norton Ave., Marion, IN 46952 | 2013-02-22 |
| 1326350844 | Beth Ellen Krouse | Speech-Language Pathologist | 1800 Wabash Ave, Suite 200, Marion, IN 46952 | 2010-07-13 |
| 1093032138 | Thomas Alfred Beck | General Practice | 919 Euclid Avenue, Marion, IN 46952 | 2010-04-29 |
| Find all providers in zip 46952 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215327705 | Melo-dee Collins | Nurse Practitioner | 330 N Wabash Ave Ste 170, Marion, IN 46952-2696 | 2015-02-04 |
| 1639422355 | Brianne P Lienkamp | Nurse Practitioner | 369 Front St, Marion, MA 02738-1538 | 2012-10-18 |
| 1457567877 | Martha Amanda Rich | Nurse Practitioner | 3501 Newark Rd, Marion, NY 14505-9644 | 2007-05-15 |
| 1164645024 | Kathleen Anne Smothers | Nurse Practitioner | 59 Gypsy Mountain Rd., Marion, NC 28752-4527 | 2007-04-10 |
| 1891172870 | Jennifer Little | Nurse Practitioner | 1700 E 38th St, Marion, IN 46953-4568 | 2015-04-29 |
| 1861880601 | Cindy Dawn Evans | Nurse Practitioner | 441 N Wabash Ave, Marion, IN 46952-2612 | 2015-01-01 |
| 1326473190 | Ann Marie Gardner Hammond | Nurse Practitioner | 2293 Sugar Hill Rd Ste A, Marion, NC 28752-7787 | 2013-09-11 |
| 1104102474 | Michelle Deane Mc Lain | Nurse Practitioner | 3333 W Deyoung St, Marion, IL 62959 | 2011-10-31 |
| 1295015188 | Daniel J Cimino | Nurse Practitioner | 130 University Dr Ste 1300, Marion, OH 43302 | 2011-08-23 |
| 1962708156 | Jamie Sue Lang | Nurse Practitioner | 1406 W Bella Dr, Marion, IN 46953-5229 | 2011-02-04 |
| Find all providers in MARION | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.