SUSAN R WALLACE (NPI# 1740537687) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740537687 |
| Entity Type | Individual |
| Full Name | SUSAN R WALLACE |
| Practice Address |
100 Methodist Blvd Hattiesburg MS 39402-1295 |
| Practice Telephone | 6012686738 |
| Mailing Telephone | 6012686738 |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2012-08-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
R852101 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477910792 | Susan Anne Wallace | Licensed Practical Nurse | 44 Beechwood Dr, Manorville, NY 11949-2947 | 2016-01-16 |
| 1376842732 | Susan Elizabeth Wallace | Dietitian, Registered | 102 Carran Dr, Lakeside Park, KY 41017-2233 | 2011-03-23 |
| 1598904427 | Susan Leigh Wallace | Specialist | 103 Windwood Rd, North Syracuse, NY 13212-1956 | 2009-02-17 |
| 1366646457 | Susan Taylor Wallace | Speech-Language Pathologist | 3409 Connection Dr, Fayetteville, NC 28311-0151 | 2007-06-12 |
| 1952426025 | Susan Wallace | Acupuncturist | 1009 Solano Ave, # A, Albany, CA 94706-1617 | 2007-03-20 |
| 1447375662 | Susan D. Wallace | Counselor | 166 Pawtucket Avenue, Pawtucket, RI 02860-3811 | 2007-03-20 |
| 1639554769 | Susan Wallace | Physical Therapist | 35 Medical Center Pkwy, Augusta, ME 04330-8160 | 2015-07-30 |
| 1710247812 | Susan Victoria Wallace | Marriage & Family Therapist | 9685 Hayes St, Riverside, CA 92503-3660 | 2012-05-22 |
| 1427203462 | Susan Marie Wallace | Occupational Therapist | 355 Oak Grove Rd, Spartanburg, SC 29301-2537 | 2008-11-18 |
| 1194985887 | Susan Jean Wallace | Registered Nurse | E Hwy 18, Pine Ridge, SD 57770-1201 | 2008-06-16 |
| Street Address |
100 METHODIST BLVD |
| City | HATTIESBURG |
| State | MS |
| Zip Code | 39402-1295 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558374850 | William M Farmer | Internal Medicine | 100 Methodist Blvd, Hattiesburg, MS 39402-1295 | 2006-08-15 |
| 1942761382 | Erin Kathleen Roberts | Nurse Practitioner | 100 Methodist Blvd, Hattiesburg, MS 39402 | 2019-03-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518572965 | Resilient Therapy and Solutions, Pllc | Clinic/Center | 5266 Old Hwy 11 Ste 50, #308, Hattiesburg, MS 39402 | 2020-09-12 |
| 1932710225 | Jones County Medical Supplies, Inc | Durable Medical Equipment & Medical Supplies | 6424 Hwy 98 West, Suite 20, Hattiesburg, MS 39402 | 2020-08-11 |
| 1467086736 | Elizabeth A. Perry | Technician | 1220 Marrie St, Hattiesburg, MS 39402 | 2020-02-26 |
| 1225678063 | Connor Gregory Galloway | Physical Therapist | 3688 Veteran Memorial Drive, Hattiesburg, MS 39402 | 2020-01-09 |
| 1487291456 | Megan Marie Smith | Social Worker | 11 Woodstone Plaza, Hattiesburg, MS 39402 | 2019-12-09 |
| 1821656612 | Julie Covington Mcmahan | Dentist | 100 Madison Plaza, Hattiesburg, MS 39402 | 2019-06-05 |
| 1295392074 | Hattiesburg Clinic, Pa | Preventive Medicine | 6414 Highway 98, Suite 120, Hattiesburg, MS 39402 | 2019-05-28 |
| 1760945356 | Rachandeep Chahal | Student in an Organized Health Care Education/Training Program | 5001 Hardy Street Merit Health Wesley, Hattiesburg, MS 39402 | 2019-04-10 |
| 1386101137 | Courtney L Smith | Behavior Technician | 32 Millbanch Road, Suite 40, Hattiesburg, MS 39402 | 2019-02-28 |
| 1891269940 | Amanda Laine Mcarthur-macisaac | Registered Nurse | 5909 Highway 49 South, Suite 30, Hattiesburg, MS 39402 | 2019-01-11 |
| Find all providers in zip 39402 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588278618 | Joshua Cole Hammons | Nurse Practitioner | 2134 Weeping Willow Cir, Hattiesburg, MS 39402-6096 | 2020-09-05 |
| 1518571900 | Lawanda Nicole Ellis | Nurse Practitioner | 4124 W 4th St Apt 2010, Hattiesburg, MS 39401-5791 | 2020-09-02 |
| 1851913768 | Maryam Rahmanian | Nurse Practitioner | 27 Lake Forgetful Apt 815, Hattiesburg, MS 39402-8288 | 2020-05-13 |
| 1477188332 | Stacy Williams | Nurse Practitioner | 18 Nicolaus Dr, Hattiesburg, MS 39402-8112 | 2020-03-10 |
| 1932740578 | Felisa Jeannette Hall | Nurse Practitioner | 216 Westover Dr, Hattiesburg, MS 39402-1374 | 2019-10-04 |
| 1164072278 | Vivian Wright Pittman | Nurse Practitioner | 108 Northwest Cir, Hattiesburg, MS 39401-4512 | 2019-09-19 |
| 1821650045 | Charlotte Denise Andrews | Nurse Practitioner | 198 Millpond Dr, Hattiesburg, MS 39401-5561 | 2019-07-08 |
| 1285107318 | Talphineta Alisha Kelly | Nurse Practitioner | 9 Waverly Cir, Hattiesburg, MS 39402-8375 | 2019-01-11 |
| 1467931642 | Shuntay Mccormick | Nurse Practitioner | 163 Augustine Dr, Hattiesburg, MS 39402-7836 | 2018-08-09 |
| 1548768260 | Tavithia Heidelburg | Nurse Practitioner | 4 Willow Pt Ste 40, Hattiesburg, MS 39402-1150 | 2018-01-28 |
| Find all providers in HATTIESBURG | ||||
| City | HATTIESBURG |
| Zip Code | 39402 |
Please comment or provide details below to improve the information on SUSAN R 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.