Donnetta L Wallace (NPI# 1922436914, PAC ID# 5799912895) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NURSE PRACTITIONER.
| Nation Provider ID (NPI) | 1922436914 |
| PAC ID by PECOS | 5799912895 |
| Professional Enrollment ID | I20131217001429 |
| Full Name | Donnetta L Wallace |
| Organization Legal Name | STELLIS HEALTH, PA |
| Address |
11091 Jason Neave Albertville MN 55301-4699 |
| Phone Number | 7636848300 |
| Gender | F |
| Graduation Year | 2013 |
| Primary Specialty | NURSE PRACTITIONER |
| Group Practice PAC ID | 1153233796 |
| Number of Group Practice Members | 62 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 240001 | NORTH MEMORIAL MEDICAL CENTER |
| 240076 | BUFFALO HOSPITAL |
| 241362 | CENTRACARE HEALTH - MONTICELLO |
| Address | Phone | Organization |
|---|---|---|
| 11091 Jason Neave, Albertville, MN 55301-4699 | 7636848300 | STELLIS HEALTH, PA |
| 1700 Hwy 25 N, Buffalo, MN 55313-1930 | STELLIS HEALTH, PA |
| Organization Legal Name | STELLIS HEALTH, PA |
| Physicians | 68 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Ashlee A Taylor | Physician Assistant | Stellis Health, Pa | 1700 Hwy 25 N, Buffalo, MN 55313-1930 |
| Jason S Halvorson | Family Medicine | Stellis Health, Pa | 11091 Jason Neave, Albertville, MN 55301-4699 |
| Arati K Gudage | Family Medicine | Stellis Health, Pa | 1001 Hart Blvd, Suite 100, Monticello, MN 55362-8929 |
| Kathryn A Alvarez | Physician Assistant | Stellis Health, Pa | 1700 Hwy 25 N, Buffalo, MN 55313-1930 |
| Cynthia L Larson | Internal Medicine | Stellis Health, Pa | 1700 Hwy 25 N, Buffalo, MN 55313-1930 |
| William J Affeldt | Clinical Social Worker | Stellis Health, Pa | 1700 Hwy 25 N, Buffalo, MN 55313-1930 |
| Ositadimma C Ugwu | Internal Medicine | Stellis Health, Pa | 1700 Hwy 25 N, Buffalo, MN 55313-1930 |
| Michael D Oborsky | Podiatry | Stellis Health, Pa | 1700 Hwy 25 N, Buffalo, MN 55313-1930 |
| John R Hering | Family Medicine | Stellis Health, Pa | 1700 Hwy 25 N, Buffalo, MN 55313-1930 |
| Patrick K Hayden | Physician Assistant | Stellis Health, Pa | 1700 Hwy 25 N, Buffalo, MN 55313-1930 |
| Street Address |
11091 JASON NEAVE |
| City | ALBERTVILLE |
| State | MN |
| Zip | 55301-4699 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jason S Halvorson | Family Medicine | Stellis Health, Pa | 11091 Jason Neave, Albertville, MN 55301-4699 |
| Franklin O Anderson | Family Medicine | Stellis Health, Pa | 11091 Jason Neave, Albertville, MN 55301-4699 |
| Anthony J Lesch | Physician Assistant | Stellis Health, Pa | 11091 Jason Neave, Albertville, MN 55301-4699 |
| Kristina M Kessler | Physician Assistant | Stellis Health, Pa | 11091 Jason Neave, Albertville, MN 55301-4699 |
| Krista M Nauman | Physician Assistant | Stellis Health, Pa | 11091 Jason Neave, Albertville, MN 55301-4699 |
| Megan Tiffany Otis | Family Medicine | Stellis Health, Pa | 11091 Jason Neave, Albertville, MN 55301-4699 |
| Keith J Edinburgh | Diagnostic Radiology | Minneapolis Radiology Associates Ltd | 11091 Jason Neave, Albertville, MN 55301-4699 |
| Richard David Belkin | Diagnostic Radiology | Minneapolis Radiology Associates Ltd | 11091 Jason Neave, Albertville, MN 55301-4699 |
| Teresa Giya Albert | Obstetrics/gynecology | Stellis Health, Pa | 11091 Jason Neave, Albertville, MN 55301-4699 |
| Sheila K Mcintire | Physician Assistant | Stellis Health, Pa | 11091 Jason Neave, Albertville, MN 55301-4699 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Andrew J Konz | Chiropractic | Chiropractic and Wellness Center of Albertville Pllc | 5676 La Centre Ave, Suite 202, Albertville, MN 55301-4023 |
| Tyler James Riesgraf | Chiropractic | Chiropractic and Wellness Center of Albertville Pllc | 5676 La Centre Ave, Suite 202, Albertville, MN 55301-4023 |
| Michael Kenneth Wotschke | Chiropractic | Chiropractic and Wellness Center of Albertville Pllc | 5676 La Centre Ave, Suite 202, Albertville, MN 55301-4023 |
| Thomas R Schwartz | Optometry | 5585 La Centre Ave, Suite 400, Albertville, MN 55301-4687 | |
| David P Wicklund | Diagnostic Radiology | Minneapolis Radiology Associates Ltd | 11091 Jason Neave, Albertville, MN 55301-4699 |
| Dennis Arthur Woolner | Diagnostic Radiology | Minneapolis Radiology Associates Ltd | 11091 Jason Neave, Albertville, MN 55301-4699 |
| Jeffrey Tyrone Kvant | Physician Assistant | Stellis Health, Pa | 11091 Jason Neave, Albertville, MN 55301-4699 |
| Teresa E Wrobbel | Family Medicine | Stellis Health, Pa | 11091 Jason Neave, Albertville, MN 55301-4699 |
| Jacob P Berwyn | Physician Assistant | Stellis Health, Pa | 11091 Jason Neave, Albertville, MN 55301-4699 |
| Joshua A Cadwallader | Physical Therapy | 6589 Laketowne Pl, Albertville, MN 55301-6500 | |
| Find all physicians in zip 55301 | |||
| City | ALBERTVILLE |
| Zip Code | 55301 |
| Specialty | NURSE PRACTITIONER |
| City + Specialty | ALBERTVILLE + NURSE PRACTITIONER |
Please comment or provide details below to improve the information on Donnetta L Wallace.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.