LISA WALLACE (NPI# 1720476641) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720476641 |
| Entity Type | Individual |
| Full Name | LISA WALLACE |
| Credential | RN |
| Practice Address |
7601 Hospital Dr Ste 202 Sacramento CA 95823-5408 |
| Mailing Address |
510 Plaza Dr Folsom CA 95630-4788 |
| Practice Telephone | 9166891062 |
| Enumeration Date | 2014-12-30 |
| Last Update Date | 2019-08-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 821591 | CA | Nursing Service Providers |
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
95006507 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396368064 | Lisa Jean Wallace | Occupational Therapy Assistant | 480 Somerset St Unit 1, North Plainfield, NJ 07060-4018 | 2020-05-28 |
| 1336779925 | Lisa Wallace | Counselor | 2769 Iris Ave Ste 107, Boulder, CO 80304-4405 | 2020-01-22 |
| 1710521968 | Lisa Anne Wallace | Counselor | 418 Barr Rd, Lexington, SC 29072-2363 | 2019-10-31 |
| 1598225930 | Lisa Buckner Wallace | Counselor | 3750 N Center St, Hickory, NC 28601-8089 | 2019-03-21 |
| 1235637182 | Lisa M. Wallace | Nurse Practitioner | 800 E Cheves St Ste 200, Florence, SC 29506-2651 | 2018-01-25 |
| 1134575475 | Lisa Wallace | Counselor | 14 Farmer Rd, Milton, MA 02186-3743 | 2016-05-05 |
| 1134438286 | Lisa M Wallace | Nurse Practitioner | 831 N Theatre Drive, Marion, IN 46952-1701 | 2010-10-06 |
| 1124002571 | Lisa M Wallace | Counselor | 1807 Capitol Ave, Suite 101 A, Cheyenne, WY 82001-4544 | 2005-11-30 |
| 1003423658 | Lisa Carol Wallace | Nurse Practitioner | 2418 180th St, Allerton, IA 50008-8715 | 2020-09-28 |
| 1992368872 | Lisa Wallace | Licensed Practical Nurse | 27777 Inkster Rd, Farmington Hills, MI 48334-5326 | 2019-04-17 |
| Street Address |
7601 HOSPITAL DR STE 202 |
| City | SACRAMENTO |
| State | CA |
| Zip Code | 95823-5408 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396343422 | Renee Yvonne Friesner | Registered Nurse | 6965 65th Street, Sacramento, CA 95823 | 2020-10-12 |
| 1790392165 | Amanda Moore | Technician | 6445 Village Center Dr, Building 7 Apt 101, Sacramento, CA 95823 | 2020-09-29 |
| 1114562766 | Daniel & Max, LLC | Optometrist | 4200 Florin Road, Suite C, Florin, CA 95823 | 2019-11-07 |
| 1396393823 | Lannon Hope Gustafson | Counselor | 8573 E Southgate Dr., Sacramento, CA 95823 | 2019-08-28 |
| 1932768280 | Sprenger Behavioral Medicine, Inc | Psychiatry & Neurology | 7601 Hospital Drive Suite 202, Suite 202, Sacramento, CA 95823 | 2019-06-11 |
| 1306316880 | Evin Johnson | Case Manager/Care Coordinator | 7000 Franklin Blvd Suite 625, Sacramento, CA 95823 | 2018-11-28 |
| 1902373095 | Alexandra L Bourcy | Family Medicine | 7275 E Southgate Dr Ste 204-206, Sacramento, CA 95823 | 2018-10-27 |
| 1891298923 | Nicholas Joseph Henderson | Behavior Technician | 6500 47th Street Apt#76, Sacramento, CA 95823 | 2018-03-15 |
| 1427567098 | Luz Maria Udave | Behavior Technician | 5435 Mack Rd Apt 87, Sacramento, CA 95823 | 2017-09-26 |
| 1417474743 | Elizabeth Smithers | Behavior Technician | 5545 Sky Parkway #202, Sacramento, CA 95823 | 2017-08-28 |
| Find all providers in zip 95823 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841571015 | Jody Pauwels | Nurse Practitioner | 3810 Rosin Ct Ste 100, Sacramento, CA 95834-1657 | 2011-09-01 |
| 1801118526 | Thao Phuong Tran | Nurse Practitioner | 100 Howe Ave Ste 220n, Sacramento, CA 95825-8221 | 2010-02-22 |
| 1174770457 | Wanda F. Willis | Nurse Practitioner | 1400 N A St, Sacramento, CA 95811-0612 | 2008-08-19 |
| 1467074328 | Francis Okodogbe | Nurse Practitioner | 2951 Fulton Ave, Sacramento, CA 95821-4909 | 2020-05-14 |
| 1831720069 | Rhea Singson Tapang | Nurse Practitioner | 350 University Ave Ste 101, Sacramento, CA 95825-6516 | 2020-01-27 |
| 1407345606 | Erica Dominga Castro | Nurse Practitioner | 401 S St, Sacramento, CA 95811-6919 | 2018-05-03 |
| 1609391713 | Ann Marie Borys | Nurse Practitioner | 2825 Capitol Ave, Sacramento, CA 95816-6039 | 2017-08-09 |
| 1003364514 | Michael Thomas Fabian | Nurse Practitioner | 2315 Stockton Blvd, Sacramento, CA 95817-2201 | 2016-09-13 |
| 1568841435 | Brenda Burnett | Nurse Practitioner | 4250 Auburn Blvd, Sacramento, CA 95841-4100 | 2015-05-26 |
| 1104192822 | Timothy Walsh Jones | Nurse Practitioner | 7700 Folsom Blvd, Sacramento, CA 95826-2608 | 2012-03-27 |
| Find all providers in SACRAMENTO | ||||
| City | SACRAMENTO |
| Zip Code | 95823 |
Please comment or provide details below to improve the information on LISA 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.