FELICIA MARIE WALLACE (NPI# 1154692523) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154692523 |
| Entity Type | Individual |
| Full Name | FELICIA MARIE WALLACE |
| Credential | FNP-BC |
| Practice Address |
16001 West 9 Mile Road Southfield MI 48075 |
| Mailing Address |
16001 West 9 Mile Road Providence Hospital Southfield MI 48075 |
| Practice Telephone | 2488492528 |
| Mailing Telephone | 2488492528 |
| Enumeration Date | 2012-01-18 |
| Last Update Date | 2014-02-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
4704238067 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215294152 | Felicia Lee Wallace | Social Worker | 100 Emancipation Dr, Bldg 71, Hampton, VA 23667-0001 | 2012-04-17 |
| Street Address |
16001 WEST 9 MILE ROAD |
| City | SOUTHFIELD |
| State | MI |
| Zip Code | 48075 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356568828 | Tareq Yousef Goussous | Internal Medicine | 16001 West 9 Mile Road, Southfield, MI 48075 | 2007-04-19 |
| 1851820641 | Independent Hospitalist Physicians, Pllc | Hospitalist | 16001 West 9 Mile Road, Southfield, MI 48075-4818 | 2017-06-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851900054 | K&b Medical Wigs, LLC | Durable Medical Equipment & Medical Supplies | 16250 Northland Dr. Ste 221, Southfield, MI 48075 | 2020-07-24 |
| 1790300390 | Julian Jeberaeel | Radiology | 2250 Providence, Southfield, MI 48075 | 2020-06-10 |
| 1265056410 | Husein Yusuf Husein | Podiatrist | Ascension Providence Hospital Southfield Campus, 16001 W. Nine Mile Rd. Depaul 2nd Floor, Southfield, Mi, MI 48075 | 2020-06-03 |
| 1952945420 | Paris Straughter | Nurse Practitioner | 18438 Onyx St, Southfield, MI 48075 | 2019-10-29 |
| 1811467657 | Medicine Man Medical, Pllc | Physical Medicine & Rehabilitation | 25130 Southfield Road, Suite #210, Southfield, MI 48075 | 2018-12-04 |
| 1447725528 | Rommel Ramos Perez | Physical Therapist | 26017 Greenfield Rd., Southfield, MI 48075 | 2018-10-04 |
| 1073009627 | Jacqueline Venora Goodgame | Licensed Practical Nurse | 4000 Town Ctr, Southfield, MI 48075 | 2018-07-06 |
| 1043712532 | Hollie Marie Maltese | Physical Therapy Assistant | 22255 Greenfiled 118, Southfield, MI 48075 | 2018-03-01 |
| 1932601481 | Katie Marie Mccormack | Occupational Therapist | 16001 West Nine Mile Rd., Southfield, MI 48075 | 2018-03-01 |
| 1801304241 | Absolute Hc LLC | Physical Therapist | 23461 Greenfield Rd Ste 200b, Southfield, MI 48075 | 2018-01-19 |
| Find all providers in zip 48075 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750999793 | Sharon Boyd | Nurse Practitioner | 16213 Lamplighter Ct Apt 1114, Southfield, MI 48075-3536 | 2020-07-15 |
| 1609414218 | Ruby Nzoma | Nurse Practitioner | 25774 Dunbar St, Southfield, MI 48033-5859 | 2019-12-13 |
| 1952945420 | Paris Straughter | Nurse Practitioner | 18438 Onyx St, Southfield, MI 48075 | 2019-10-29 |
| 1093364473 | Abra Perlman | Nurse Practitioner | 17309 Hilton St, Southfield, MI 48075-7018 | 2019-09-08 |
| 1154980134 | Ahmed Rezk | Nurse Practitioner | 29877 Telegraph Rd Ste 301, Southfield, MI 48034-7660 | 2019-06-12 |
| 1841857885 | Laronda Morenike Allen | Nurse Practitioner | 18272 New Hampshire Dr, Southfield, MI 48075-8102 | 2019-05-24 |
| 1902374986 | Theresa Owusu-ansah | Nurse Practitioner | 26206 W 12 Mile Rd Ste 302, Southfield, MI 48034-8501 | 2018-11-07 |
| 1003381500 | Theonna Monique Hindmon-harris | Nurse Practitioner | 21700 Northwestern Hwy Ste 815, Southfield, MI 48075-4922 | 2018-10-10 |
| 1922592872 | Melanie Jenkins | Nurse Practitioner | 23407 Park Place Dr, Southfield, MI 48033-7116 | 2018-06-14 |
| 1487155024 | Timothy O Gates | Nurse Practitioner | 16250 Northland Dr Ste 369, Southfield, MI 48075-1524 | 2018-02-27 |
| Find all providers in SOUTHFIELD | ||||
| City | SOUTHFIELD |
| Zip Code | 48075 |
Please comment or provide details below to improve the information on FELICIA MARIE WALLACE.
| 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.