LAURY M WALLACE (NPI# 1205343845) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1205343845 |
Entity Type | Individual |
Full Name | LAURY M WALLACE |
Credential | NP |
Practice Address |
16731 Gaither Blvd Westfield IN 46074-4607 |
Mailing Address |
16731 Gaither Blvd Westfield IN 46074-4421 |
Practice Telephone | 3175616840 |
Practice Fax Number | 8122393771 |
Mailing Telephone | 8122393771 |
Enumeration Date | 2018-01-04 |
Last Update Date | 2018-01-04 |
Gender Code | F |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 207QA0000X |
Family Medicine Specialization: Adolescent Medicine |
71007724A | IN | Allopathic & Osteopathic Physicians |
Y | 207QA0505X |
Family Medicine Specialization: Adult Medicine |
71007724A | IN | Allopathic & Osteopathic Physicians |
N | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
71007724A | IN | Allopathic & Osteopathic Physicians |
N | 207QH0002X |
Family Medicine Specialization: Hospice and Palliative Medicine |
71007724A | IN | Allopathic & Osteopathic Physicians |
Street Address |
16731 GAITHER BLVD |
City | WESTFIELD |
State | IN |
Zip Code | 46074-4607 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1477191088 | Jessica Lynn Kutz | Specialist/Technologist | 19000 E 191st Street, Suite K, Westfield, IN 46074 | 2019-12-13 |
1851805774 | Hook Superx LLC | Durable Medical Equipment & Medical Supplies | 1447 South Waterleaf Dr, Westfield, IN 46074 | 2017-11-30 |
1760939946 | Accelerated Rehabilitation Centers, Ltd. | Physical Therapist | 956 Tournament Trail, Westfield, IN 46074 | 2016-09-06 |
1285188805 | Hook-superx, L.L.C. | Durable Medical Equipment & Medical Supplies | 16088 Spring Mill Station Dr, Westfield, IN 46074 | 2016-08-11 |
1740608157 | Kumar Mokkala | Physical Therapist | 14902 Shelborne Road, Westfield, IN 46074 | 2014-04-02 |
1649608886 | Carol Hooe Hughes | Counselor | 14126 Secretariat Ct, Carmel, IN 46074 | 2013-10-25 |
1043657166 | Krause Dental | Clinic/Center | 3247 East Sr32, Westfield, IN 46074 | 2013-05-30 |
1841539517 | Ruby Christina Burris | Marriage & Family Therapist | 120 Camilla Court, Suite D, Westfield, IN 46074 | 2013-01-31 |
1720355704 | Drew Jacobson | Physical Therapy Assistant | 16620 Lakeville Crossing, Westfield, IN 46074 | 2011-11-19 |
1841491271 | Glenda Janine Huffman | Physical Therapist | 614 Apollo Pky, Westfield, IN 46074 | 2007-05-31 |
Find all providers in zip 46074 |
Taxonomy Code | 207QA0505X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Family Medicine |
Specialization | Adult Medicine |
Definition to come. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1023153640 | Family Medicine Associates | Family Medicine | 75 Springfield Rd, Suite 1, Westfield, MA 01085-1832 | 2007-02-21 |
1245269364 | Russell S Elwell | Family Medicine | 158 E Main St, Westfield, NY 14787-1155 | 2006-07-01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1316591829 | Grogan Family Medicine LLC | Family Medicine | 3024 Ohio Ave, Connersville, IN 47331-3073 | 2019-08-01 |
1366901696 | Signal Business Administration Inc | Family Medicine | 135 Jordan Rd, Indianapolis, IN 46217-4003 | 2019-03-16 |
1700393741 | Jeffrey N De Wester Treatment and Research Center, LLC | Family Medicine | 6447 S East St Ste C, Indianapolis, IN 46227-2119 | 2017-12-29 |
1760757645 | Jimmy Floyd Sharp | Family Medicine | 2012 Market St, Charlestown, IN 47111-1729 | 2012-03-12 |
1598893752 | William Dudley Ritchie | Family Medicine | 567 E Olmstead Ave, Evansville, IN 47711-3333 | 2007-03-01 |
1629119177 | Stephanie M Johnson Md LLC | Family Medicine | 274 Hannah Ave, Seymour, IN 47274-4058 | 2007-02-09 |
1932253994 | Robert S. Hojnicki | Family Medicine | 1812 E Crystal Creek Dr, Terre Haute, IN 47802-4897 | 2007-01-23 |
1316966948 | Paul Joseph Brownson | Family Medicine | 762 Franklin Trce, Zionsville, IN 46077-1165 | 2006-07-18 |
1568413680 | J Nathan Sherlock | Family Medicine | 1241 Central Ave, Indianapolis, IN 46202-2613 | 2006-05-13 |
1275511586 | Rodney J Anderson | Family Medicine | 1300 N Pennsylvania St, Suite 200, Indianapolis, IN 46202-4453 | 2006-01-06 |
Find all providers with the same taxonomy |
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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.