MICHAEL T WALLACE (NPI# 1194029777) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194029777 |
| Entity Type | Individual |
| Full Name | MICHAEL T WALLACE |
| Credential | ARNP |
| Practice Address |
9900 Bren Rd E Minnetonka MN 55343-9664 |
| Mailing Address |
Po Box 953 Coleman FL 33521-0953 |
| Practice Telephone | 3525297314 |
| Mailing Telephone | 3522540153 |
| Enumeration Date | 2010-12-22 |
| Last Update Date | 2020-09-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
7139-33 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
ARNP2975042 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | DEA | MW4048559 | 01 |
| FL | 007980600 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417014424 | Michael J Wallace | Dentist | 1600 E 19th St, Suite 301, Edmond, OK 73013-6622 | 2007-01-02 |
| 1518042696 | Michael J. Wallace | Dentist | 1263 High St, Auburn, CA 95603-5016 | 2006-10-26 |
| 1124127279 | Michael James Wallace | Dentist | 1195 W Mason St, Green Bay, WI 54303-2045 | 2006-09-22 |
| 1679585038 | Michael Patrick Wallace | Dentist | 9225 Manchester Rd, Suite 101, Saint Louis, MO 63144-2640 | 2006-08-13 |
| 1467438937 | Michael Lloyd Wallace | Pathology | 522 Alpha Dr, Pittsburgh, PA 15238-2912 | 2005-12-16 |
| 1609356864 | Michael Wallace | Physical Therapy Assistant | 5455 Knickerbocker Rd, San Angelo, TX 76904-7711 | 2018-08-17 |
| 1225579899 | Michael Wallace | Counselor | 500 Allerton St, Second Floor, Redwood City, CA 94063-1519 | 2017-03-16 |
| 1376922948 | Michael Taylor Wallace | Ophthalmology | 930 Madison Ave Ste 200, Memphis, TN 38103 | 2015-05-28 |
| 1003116658 | Michael Eugene Wallace | Psychologist | 201 E Liberty St, Suite 2, Ann Arbor, MI 48104-2118 | 2010-10-29 |
| 1003057852 | Michael Alan Wallace | Nurse Practitioner | 8210 Louisiana Blvd Ne, Suite C, Albuquerque, NM 87113-1761 | 2009-03-07 |
| Street Address |
9900 BREN RD E |
| City | MINNETONKA |
| State | MN |
| Zip Code | 55343-9664 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194720557 | Dawn M Berger | Nurse Practitioner | 9900 Bren Rd E, Mail Route Mn 008-b213, Minnetonka, MN 55343-9664 | 2005-06-14 |
| 1447866652 | Tana Desimone | Internal Medicine | 9900 Bren Rd E, Minnetonka, MN 55343-9664 | 2020-09-22 |
| 1467078691 | Candy Ray Jones | Nurse Practitioner | 9900 Bren Rd E, Minnetonka, MN 55343-9664 | 2020-06-23 |
| 1295366813 | Ashley Brimmer | Nurse Practitioner | 9900 Bren Rd E, Minnetonka, MN 55343-9664 | 2020-02-02 |
| 1134770621 | Reagan Walls | Nurse Practitioner | 9900 Bren Rd E, Minnetonka, MN 55343-9664 | 2019-09-25 |
| 1700448073 | Tara Carroll | Nurse Practitioner | 9900 Bren Rd E, Minnetonka, MN 55343-9664 | 2019-07-08 |
| 1831753326 | Tiffany Lager Wyttenbach | Nurse Practitioner | 9900 Bren Rd E, Minnetonka, MN 55343-9664 | 2019-04-30 |
| 1386104180 | Kutreni Lachelle Carter | Nurse Practitioner | 9900 Bren Rd E, Minnetonka, MN 55343-9664 | 2019-03-20 |
| 1962962530 | Denise Pennicooke | Nurse Practitioner | 9900 Bren Rd E, Minnetonka, MN 55343-9664 | 2019-03-20 |
| 1588122378 | Clerisse Ann Ewelike | Nurse Practitioner | 9900 Bren Rd E, Mail Route Mn 008-b213, Minnetonka, MN 55343-9664 | 2019-03-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689230542 | Madison C Korus | Behavior Technician | 5501 Feltl Road, Minnetonka, MN 55343 | 2019-05-16 |
| 1942708508 | Teammd Physicians of Texas Inc | Case Manager/Care Coordinator | 9900 Bren Rd E # 8-b217, Minnetonka, MN 55343 | 2018-01-30 |
| 1659899284 | Midwest Medical Transit | Transportation Broker | 1001 Main Street #125, Hopkins, MN 55343 | 2017-09-04 |
| 1376070367 | Noor Translation and Interpretation Services LLC | Interpreter | 5620 Smetana Drive, Ste 300, Office D, Minnetonka, MN 55343 | 2017-05-22 |
| 1871043240 | Katherine Rae Skarphol | Speech-Language Pathologist | 5501 Feltl Rd, Hopkins, MN 55343 | 2016-10-10 |
| 1215481478 | Safi Care Transportation | Non-emergency Medical Transport (VAN) | 1001 Mainstreet, Ste 125, Hopkins, MN 55343 | 2016-08-05 |
| 1649723420 | Stephanie Stackhouse | Internal Medicine | 5520 Bristol Lane, Minnetonka, MN 55343 | 2016-07-28 |
| 1023479706 | Counter Point Recovery | Substance Abuse Rehabilitation Facility | 5022 Baker Rd, Minnetonka, MN 55343 | 2016-03-09 |
| 1851766356 | Enrique Mendoza Rojas | Nurse Practitioner | 9900 Ben Road East, Mail Route Mn 008-b213, Minnetonka, MN 55343 | 2015-12-09 |
| 1013307230 | Susanna Monroe | Nurse Practitioner | Unitedhealth Group Corporate Address, 9900 Bren Road East, Minnetonka, MN 55343 | 2015-01-26 |
| Find all providers in zip 55343 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164896379 | Brooke Johnson | Nurse Practitioner | 12700 Whitewater Dr, Minnetonka, MN 55343-9438 | 2015-11-25 |
| 1649446246 | Leigh Hammond | Nurse Practitioner | 9900 Bren Road East Mail Route Mn 008-b213, Minnetonka, MN 55343-9664 | 2008-05-02 |
| 1902894348 | Suzanne M Oliver | Nurse Practitioner | 401 Carlson Pkwy, Mail Route Cp320, Minnetonka, MN 55305-5359 | 2005-10-10 |
| 1699234609 | Melissa Bolles | Nurse Practitioner | 12700 Whitewater Dr, Minnetonka, MN 55343-9438 | 2019-03-19 |
| 1689148942 | Vanessa Ann Figueroa | Nurse Practitioner | 9900 Bren Rd E, Minnetonka, MN 55343-9664 | 2019-01-18 |
| 1083184709 | Leah Rose Brown | Nurse Practitioner | 9900 Bren Rd E, Minnetonka, MN 55343-9664 | 2018-11-26 |
| 1699241752 | Kim B Lackey | Nurse Practitioner | 9900 Bren Rd E, Minnetonka, MN 55343-9664 | 2018-10-16 |
| 1487135059 | Ada Y. Martinez | Nurse Practitioner | 9900 Bren Rd E, Minnetonka, MN 55343-9664 | 2018-08-22 |
| 1720585326 | Amy Marie Ringwald | Nurse Practitioner | 401 Carlson Pkwy, Minnetonka, MN 55305-5359 | 2018-04-10 |
| 1497268429 | Erin Watts | Nurse Practitioner | 9900 Bren Road East, Mail Route Mn 008-b213, Minnetonka, MN 55343-1357 | 2017-11-13 |
| Find all providers in MINNETONKA | ||||
| City | MINNETONKA |
| Zip Code | 55343 |
Please comment or provide details below to improve the information on MICHAEL T 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.