DAVID WALLSTROM (NPI# 1427589670) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427589670 |
| Entity Type | Individual |
| Full Name | DAVID WALLSTROM |
| Credential | PA-C |
| Practice Address |
160 Allen Street Emergency Department Rutland VT 05701 |
| Mailing Address |
160 Allen Street Medical Staff Services Rutland VT 05701 |
| Practice Telephone | 8027473601 |
| Mailing Telephone | 8027473639 |
| Mailing Fax Number | 8027476207 |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2017-03-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
160 ALLEN STREET EMERGENCY DEPARTMENT |
| City | RUTLAND |
| State | VT |
| Zip Code | 05701 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003899667 | Deborah A Henley | Orthopaedic Surgery | 160 Allen Street, Medical Staff Services, Rutland, VT 05701 | 2005-11-28 |
| 1053548727 | John C Hergert | Nurse Anesthetist, Certified Registered | 160 Allen Street, Rutland, VT 05701 | 2009-06-19 |
| 1720223589 | William Paul Tarrant | Pathology | 160 Allen Street, Rutland Regional Medical Center, Rutland, VT 05701 | 2008-12-09 |
| 1316085814 | Mid Vermont Pathology PC | Pathology | 160 Allen Street, Rutland Regional Medical Center, Rutland, VT 05701 | 2007-02-05 |
| 1881769107 | Stephen M Knisely | Social Worker | 160 Allen Street, Rutland Regional Medical Center, Rutland, VT 05701 | 2006-11-21 |
| 1275614653 | Amy Marie Gjerde | Anesthesiology | 160 Allen Street, Rutland, VT 05701 | 2006-10-18 |
| 1447208269 | William Bradford Hoge Bissell | Internal Medicine | 160 Allen Street, Rutland Regional Medical Center, Rutland, VT 05701 | 2006-05-04 |
| 1336103597 | Timothy A. Daly | Anesthesiology | 160 Allen Street, Rutland, VT 05701 | 2006-04-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639721186 | All Dimensions Primary Care Pllc | Physician Assistant | 92 Allen Street, Rutland, VT 05701 | 2019-07-15 |
| 1962809053 | Laura Kalinen Laprise | Nurse Practitioner | Rutland Community Health Center, 215 Stratton Road, Rutland, VT 05701 | 2014-12-04 |
| 1962818781 | Andrea Louise Welch | Pharmacist | 1 Rutland Shopping Plaza, Rutland, VT 05701 | 2014-07-02 |
| 1396158903 | Gwendolyn Koenig | Counselor | 78 South Main St., Rutland, VT 05701 | 2014-06-11 |
| 1194088195 | Marcie Bouchard | Early Intervention Provider Agency | 24a East Street, Rutland, VT 05701 | 2012-06-25 |
| 1790047009 | Pamela Lenoci | Massage Therapist | 196 Joshua Place, Rutland, VT 05701 | 2012-06-12 |
| 1528339959 | Deborah E. Boston | Social Worker | 128 Merchants Row Ste 510, Rutland, VT 05701 | 2012-01-17 |
| 1235431834 | Alicia Marie Riesterer | Occupational Therapy Assistant | 46 Nichols St., Rutland Healthcare and Rehabilitation Center, Rutland, VT 05701 | 2010-12-02 |
| 1497085401 | Lauren Ann Lasante | Counselor | 198 N Main St Ste C-5, Rutland, VT 05701 | 2010-01-14 |
| 1568692515 | Steven C. Duboff, Dmd, PC | Dentist | 198 North Main St, Rutland, VT 05701 | 2009-07-23 |
| Find all providers in zip 05701 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013938992 | Abigail Rose Brown | Physician Assistant | 173 S Main St, Rutland, VT 05701-4713 | 2006-07-23 |
| 1184163297 | Blake Lopes | Physician Assistant | 6 Commons St, Rutland, VT 05701-4651 | 2017-02-22 |
| 1376081034 | Jennifer Kish Hopkins | Physician Assistant | 160 Allen St, Rutland, VT 05701-4560 | 2017-02-02 |
| 1174076152 | Jessica J Baughman | Physician Assistant | 160 Allen St, Rutland, VT 05701-4560 | 2016-07-26 |
| 1427156041 | Linda Marie Mckenna | Physician Assistant | 160 Allen St, Rutland, VT 05701-4560 | 2006-09-20 |
| 1770681587 | Michael P Vooris | Physician Assistant | 160 Allen St, Rutland, VT 05701-4560 | 2006-09-20 |
| 1366453573 | Regina Catherine Springer | Physician Assistant | 71 Allen St, Suite 203, Rutland, VT 05701-4570 | 2006-08-11 |
| 1124042163 | Robert G. Mitchell | Physician Assistant | 160 Allen St, Rutland, VT 05701-4560 | 2006-07-26 |
| 1306802194 | Timothy J Lensing | Physician Assistant | 215 Stratton Rd, Rutland, VT 05701-4621 | 2006-04-21 |
| 1669449278 | Kerry Brennan Finch | Physician Assistant | 69 Allen St, Suite 1, Rutland, VT 05701-4564 | 2006-03-02 |
| Find all providers in RUTLAND | ||||
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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.