MARLENE T WALLACE (NPI# 1780665521) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780665521 |
| Entity Type | Individual |
| Full Name | MARLENE T WALLACE |
| Credential | RN, FNP-C |
| Practice Address |
1142 N Broome St Waxhaw NC 28173-9378 |
| Mailing Address |
5808 Mcwhorter Rd Waxhaw NC 28173-8202 |
| Practice Telephone | 7048434680 |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2009-06-16 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
201319 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629037676 | Marlene M.b. Wallace | Registered Nurse | 5955 Zeamer Ave, 673rd Medical Group/sghq Dod-va Joint Venture Hospital, Jber, AK 99506-3702 | 2006-03-20 |
| Street Address |
1142 N BROOME ST |
| City | WAXHAW |
| State | NC |
| Zip Code | 28173-9378 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508473612 | Kasey Wheeler | Pharmacist | 1142 N Broome St, Waxhaw, NC 28173-9378 | 2020-09-23 |
| 1033525464 | Caitlyn Anderson | Pharmacist | 1142 N Broome St, Waxhaw, NC 28173-9378 | 2014-07-07 |
| 1346678174 | Elisa Edgerton | Nurse Practitioner | 1142 N Broome St, Waxhaw, NC 28173-9378 | 2013-10-14 |
| 1467757526 | Ryan William Petronis | Pharmacist | 1142 N Broome St, Waxhaw, NC 28173-9378 | 2011-01-21 |
| 1790978609 | Christina Updike | Nurse Practitioner | 1142 N Broome St, Waxhaw, NC 28173-9378 | 2007-08-23 |
| 1528162294 | North Carolina Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 1142 N Broome St, Waxhaw, NC 28173-9378 | 2006-09-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033733175 | Publix North Carolina, Lp | Durable Medical Equipment & Medical Supplies | 1615 Providence Road South, Marvin, NC 28173 | 2020-06-04 |
| 1225507320 | Shane Markey Dds Ms Pllc | Dentist | 8412 New Town Rd Ste A, Waxhaw, NC 28173 | 2018-11-19 |
| 1336631514 | Suganya Nelatoor,d.d.s.,p.l.l.c. | Clinic/Center | 102 E Waxhaw Professional Park Drive, Waxhaw, NC 28173 | 2018-06-04 |
| 1184120750 | Restore Healthcare Medical Group | Counselor | 500 Waxhaw Professional Park Drive, Ste 105 F, Waxhaw, NC 28173 | 2018-04-03 |
| 1730690827 | Concrete Roses Consulting | Community/Behavioral Health | 5960 Fairview Road, 323, Charlotte, NC 28173 | 2017-10-17 |
| 1861849523 | Kayla Selena Caldwell | Social Worker | 3908 Rev. H. Morrison Rd., Waxhaw, NC 28173 | 2016-05-23 |
| 1588023782 | Teri Hipp | Counselor | 101-e Waxhaw Professional Park Drive, Waxhaw, NC 28173 | 2016-02-16 |
| 1710355508 | Caresmatic Phase 1,inc. | Assisted Living Facility | 520 Pembroke Ln., Waxhaw, NC 28173 | 2015-09-10 |
| 1437564838 | Anna Waddell Schneiderman | Counselor | 104 Waxhaw Professional Park Drive, Waxhaw, NC 28173 | 2014-06-24 |
| 1467892109 | Samantha Weidele Waldman | Counselor | 9929 Rea Rd Ste 201, Waxhaw, NC 28173 | 2013-06-26 |
| Find all providers in zip 28173 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215385463 | Prosper At Home Health Care Services LLC | Nurse Practitioner | 7319 Yellowhorn Trl, Waxhaw, NC 28173-7465 | 2016-05-27 |
| 1548675648 | Veronica Southerland | Nurse Practitioner | 8129 Madrigal Ct, Waxhaw, NC 28173-8099 | 2014-06-26 |
| 1346461431 | Ngozi Nnaji | Nurse Practitioner | 307 Wild Laurel Ct, Waxhaw, NC 28173-6101 | 2007-05-02 |
| 1508909409 | Shirley Hutchins | Nurse Practitioner | 1316 Crane Rd, Waxhaw, NC 28173-8555 | 2007-02-14 |
| 1366507584 | Joan Marie Dickey | Nurse Practitioner | 6705 Wycliffe Ave., Jaars Health Services, Waxhaw, NC 28173-0248 | 2006-12-27 |
| 1346678174 | Elisa Edgerton | Nurse Practitioner | 1142 N Broome St, Waxhaw, NC 28173-9378 | 2013-10-14 |
| 1790978609 | Christina Updike | Nurse Practitioner | 1142 N Broome St, Waxhaw, NC 28173-9378 | 2007-08-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043811144 | Alice Bradshaw Callis | Nurse Practitioner | 110 Widgeon Dr, Currituck, NC 27929-9628 | 2020-11-04 |
| 1417558990 | Munira Amirali Ward | Nurse Practitioner | 2617 Valley Haven Dr, Raleigh, NC 27603-3197 | 2020-11-03 |
| 1245830215 | Whitney Rains Taheri | Nurse Practitioner | 3004 Tower Blvd, Durham, NC 27707-2542 | 2020-10-29 |
| 1972103232 | Tauscha Alyse Gerald | Nurse Practitioner | 48 Flora Dr, Benson, NC 27504-8076 | 2020-10-27 |
| 1265031413 | Autumn Grimm | Nurse Practitioner | 511 Lauchwood Dr, Laurinburg, NC 28352-5502 | 2020-10-20 |
| 1619576857 | Candace Allen | Nurse Practitioner | 1215 W Clemmonsville Rd, Winston Salem, NC 27127-4521 | 2020-10-20 |
| 1952900268 | Jennifer Marie Wolfe | Nurse Practitioner | 831 E Morehead St Ste 900, Charlotte, NC 28202-2726 | 2020-10-19 |
| 1720686256 | Sheri Elizabeth Maclean | Nurse Practitioner | 117 Ivy Brook Ln, Chapel Hill, NC 27516-8084 | 2020-10-16 |
| 1326645649 | Christina Mccartney Bulluck | Nurse Practitioner | 105 Nassau Ct, Nashville, NC 27856-1656 | 2020-10-09 |
| 1609473172 | Amy Marie Errichetti | Nurse Practitioner | 1349 Upper Brush Creek Rd, Fairview, NC 28730-9217 | 2020-10-07 |
| Find all providers with the same taxonomy | ||||
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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.