LAURY M WALLACE


Address: 16731 Gaither Blvd, Westfield, IN 46074-4607
Phone: 3175616840

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).

Provider Overview

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

Taxonomy

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

Office Location

Street Address 16731 GAITHER BLVD
City WESTFIELD
State IN
Zip Code 46074-4607

Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 207QA0505X
Grouping Allopathic & Osteopathic Physicians
Classification Family Medicine
Specialization Adult Medicine

Taxonomy Definition

Definition to come.

Providers in the same taxonomy and city

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

Providers in the same taxonomy and state

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
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Competitor

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City WESTFIELD
Zip Code 46074

Improve Information

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Dataset Information

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.

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