JENNIFER M WALLACE (NPI# 1235379090) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235379090 |
| Entity Type | Individual |
| Full Name | JENNIFER M WALLACE |
| Credential | NP |
| Practice Address |
3640 Main St Suite 302 Springfield MA 01107-1145 |
| Practice Telephone | 4137324242 |
| Practice Fax Number | 4137324040 |
| Mailing Telephone | 4137324242 |
| Mailing Fax Number | 4137324040 |
| Enumeration Date | 2009-03-05 |
| Last Update Date | 2016-04-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | RN218174 | MA | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356968440 | Jennifer Wallace | Technician/Technologist | 2041 E 3rd Dr, Mesa, AZ 85204-1401 | 2020-07-06 |
| 1497249882 | Jennifer Laird Wallace | Licensed Practical Nurse | 4468 Duff Rd, Livingston, TX 77351-5627 | 2018-06-19 |
| 1124579602 | Jennifer Marie Wallace | Acupuncturist | 237 Avenida Del Norte, Redondo Beach, CA 90277-5702 | 2016-10-19 |
| 1174926984 | Jennifer Wallace | Specialist/Technologist | 806 Patton Chapel Trl, Hoover, AL 35226-2254 | 2014-10-07 |
| 1295083897 | Jennifer Wallace | Psychologist | 4226 Green Lake Rd, West Bloomfield, MI 48323-1139 | 2012-08-29 |
| 1669799086 | Jennifer Renea Wallace | Counselor | 3802 W University Blvd Apt 8104, Durant, OK 74701-3047 | 2010-04-24 |
| 1306035431 | Jennifer L Wallace | Physical Therapist | 3891 50th Ave S, Saint Petersburg, FL 33711-4811 | 2007-10-15 |
| 1316974058 | Jennifer Wallace | Speech-Language Pathologist | 1901 Century Blvd Ne Ste 20, Atlanta, GA 30345-3300 | 2006-06-27 |
| 1992766570 | Jennifer P Wallace | Specialist | 64400 E 26th Ct, Byers, CO 80103-8539 | 2006-03-31 |
| 1730154154 | Jennifer Lyn Wallace | Family Medicine | 1235 Se Division St, Suite 208, Portland, OR 97202-1099 | 2006-02-20 |
| Street Address |
3640 MAIN ST SUITE 302 |
| City | SPRINGFIELD |
| State | MA |
| Zip Code | 01107-1145 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508851411 | Mark A Jackowitz | Specialist | 3640 Main St, Suite 205, Springfield, MA 01107-1145 | 2005-09-16 |
| 1578093027 | Kathryn Ann Janikas | Physician Assistant | 3640 Main St, Springfield, MA 01107-1145 | 2017-06-18 |
| 1750818456 | Urologic Surgeons of New England, LLC | Urology | 3640 Main St, Suite 103, Springfield, MA 01107-1145 | 2017-05-12 |
| 1518324904 | Ryan Leigh Macdonald | Physician Assistant | 3640 Main St, Suite 302, Springfield, MA 01107-1145 | 2016-01-15 |
| 1750766853 | K. Francis Lee, M.d., P.C. | Surgery | 3640 Main St, Suite 302, Springfield, MA 01107-1145 | 2015-07-30 |
| 1053742098 | Michelle Sheehan | Nurse Practitioner | 3640 Main St, Suite 208, Springfield, MA 01107-1145 | 2013-12-02 |
| 1821435553 | Chelmsford Mri, P.C. | Radiology | 3640 Main St, Suite 101, Springfield, MA 01107-1145 | 2013-06-04 |
| 1134465545 | K. Francis Lee, M.d., P.C. | Surgery | 3640 Main St, Suite 302, Springfield, MA 01107-1145 | 2012-12-13 |
| 1831447820 | Gina Marie Lewis | Physician Assistant | 3640 Main St, Springfield, MA 01107-1145 | 2012-08-22 |
| 1376805978 | Paul Sciarretta | Technician/Technologist | 3640 Main St, Suite 206, Springfield, MA 01107-1145 | 2012-06-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740702547 | Domingo Nieves Jr. | Counselor | 2225 Main St., Springfield, MA 01107 | 2017-07-13 |
| 1801318266 | Denise Lawson | Counselor | 2257 Main Street, Springfield, MA 01107 | 2017-07-07 |
| 1568912491 | Trina Cysz | Nurse Practitioner | 101 Wason Avenue, Commonwealth Care Alliance, Springfield, MA 01107 | 2016-10-04 |
| 1609322262 | Toheeb Oladimeji Bakare | Counselor | 322 Birnie Avenue, Springfield, MA 01107 | 2016-09-01 |
| 1952701161 | Jalissa Sostre | Counselor | 32 Abbe Ave, Springfield, MA 01107 | 2014-08-26 |
| 1659799161 | Elizabeth A. Otmaskin | Obstetrics & Gynecology | 3455 Main Street Suite C, Baysttate Ob Gyn Group Inc, Springfield, MA 01107 | 2014-04-01 |
| 1205268885 | Catherine Matejcek Davies | Counselor | 246 Park Street, Springfield, MA 01107 | 2013-08-06 |
| 1750723268 | Jasdeep S. Badwal | Allergy & Immunology | 2 Medical Center Dr Ste 406, Springfield, MA 01107 | 2013-07-25 |
| 1255691846 | Medical Express Urgent Care Center, Co. Inc. | Physical Medicine & Rehabilitation | 438 Chestnut Street, Springfield, MA 01107 | 2012-05-17 |
| 1205166642 | Matthew R Kelley | Audiologist | 100 Wason, Suite 100, Springfield, MA 01107 | 2010-01-07 |
| Find all providers in zip 01107 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578178422 | Behishta Ishanzai | Nurse Practitioner | 7500 Geoint Dr, Springfield, VA 22150-7500 | 2020-09-08 |
| 1790393049 | Kathy Forson | Nurse Practitioner | 1235 E. Cherokee St., Springfield, MO 65804 | 2020-07-22 |
| 1255951331 | Bryndi Raye Shirley | Nurse Practitioner | 1636 S Glenstone Ave Ste 100, Springfield, MO 65804-1527 | 2020-04-20 |
| 1750900379 | Gemma Nicole D'angelo | Nurse Practitioner | 996 Stoneybrook Dr, Springfield, PA 19064-3829 | 2020-04-14 |
| 1629607882 | Melanie Herrin | Nurse Practitioner | 6230 Rolling Rd Ste J, Springfield, VA 22152-2326 | 2020-04-08 |
| 1871133520 | Deborah Ann Tully | Nurse Practitioner | 2 Medical Center Dr Ste 202, Springfield, MA 01107-1272 | 2020-01-10 |
| 1932759651 | Amanda Couchon | Nurse Practitioner | 759 Chestnut St Radiology Department, Springfield, MA 01199-0001 | 2019-09-14 |
| 1760947410 | Andrea K Leger | Nurse Practitioner | 300 Birnie Ave Ste 102, Springfield, MA 01107-1375 | 2019-02-07 |
| 1417421579 | Stephanie M Yeager | Nurse Practitioner | 3850 S National Ave Ste 700, Springfield, MO 65807-5292 | 2019-01-11 |
| 1215415799 | Bree Schmulbach | Nurse Practitioner | Bsb Room 20, Springfield, IL 62703 | 2018-08-06 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 01107 |
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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.