MR. MICHAEL ALAN WALLACE (NPI# 1003057852) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003057852 |
| Entity Type | Individual |
| Full Name | MR. MICHAEL ALAN WALLACE |
| Credential | CNP |
| Practice Address |
8210 Louisiana Blvd Ne Suite C Albuquerque NM 87113-1761 |
| Practice Telephone | 5058581222 |
| Practice Fax Number | 5058581224 |
| Mailing Telephone | 5058581222 |
| Mailing Fax Number | 5058581224 |
| Enumeration Date | 2009-03-07 |
| Last Update Date | 2013-03-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
R48828 | NM | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | 29623341 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417014424 | Michael J Wallace | Dentist | 1600 E 19th St, Suite 301, Edmond, OK 73013-6622 | 2007-01-02 |
| 1518042696 | Michael J. Wallace | Dentist | 1263 High St, Auburn, CA 95603-5016 | 2006-10-26 |
| 1124127279 | Michael James Wallace | Dentist | 1195 W Mason St, Green Bay, WI 54303-2045 | 2006-09-22 |
| 1679585038 | Michael Patrick Wallace | Dentist | 9225 Manchester Rd, Suite 101, Saint Louis, MO 63144-2640 | 2006-08-13 |
| 1467438937 | Michael Lloyd Wallace | Pathology | 522 Alpha Dr, Pittsburgh, PA 15238-2912 | 2005-12-16 |
| 1609356864 | Michael Wallace | Physical Therapy Assistant | 5455 Knickerbocker Rd, San Angelo, TX 76904-7711 | 2018-08-17 |
| 1225579899 | Michael Wallace | Counselor | 500 Allerton St, Second Floor, Redwood City, CA 94063-1519 | 2017-03-16 |
| 1376922948 | Michael Taylor Wallace | Ophthalmology | 930 Madison Ave Ste 200, Memphis, TN 38103 | 2015-05-28 |
| 1194029777 | Michael T Wallace | Nurse Practitioner | 9900 Bren Rd E, Minnetonka, MN 55343-9664 | 2010-12-22 |
| 1003116658 | Michael Eugene Wallace | Psychologist | 201 E Liberty St, Suite 2, Ann Arbor, MI 48104-2118 | 2010-10-29 |
| Street Address |
8210 LOUISIANA BLVD NE SUITE C |
| City | ALBUQUERQUE |
| State | NM |
| Zip Code | 87113-1761 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982671269 | Valerie Ann Wroblewski | Dentist | 8210 Louisiana Blvd Ne, Ste. A, Albuquerque, NM 87113-2105 | 2006-03-04 |
| 1760863955 | John Emery Salazar | Nurse Practitioner | 8210 Louisiana Blvd Ne, Suite C, Albuquerque, NM 87113-1760 | 2015-06-12 |
| 1497868624 | April H Volk | Internal Medicine | 8210 Louisiana Blvd Ne, C, Albuquerque, NM 87113-1760 | 2006-08-15 |
| 1376540781 | Geriatrics Associates PC | Family Medicine | 8210 Louisiana Blvd Ne, Suite C, Albuquerque, NM 87113-1760 | 2005-06-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952944613 | Wendy Valenciano Flores | Behavior Technician | 9019 Washington St Ne Building A, Albuquerque, NM 87113 | 2019-10-24 |
| 1336608504 | Southwestern Provider Services LLC | Registered Nurse | 6400 Paseo Del Norte, Albuquerque, NM 87113 | 2019-03-18 |
| 1376047795 | Anne K. Hempstead D.d.s., P.C. | Dentist | 6400 Holly Ave Ne Ste M, Albuquerque, NM 87113 | 2018-03-20 |
| 1447769518 | Ethan Grant | Behavior Technician | 8500 Washington St Ste A1, Albuquerque, NM 87113 | 2017-09-21 |
| 1215451083 | Sarah Bartlett | Behavior Technician | 8500 Washington St, Ste A1, Albuquerque, NM 87113 | 2017-08-02 |
| 1396109906 | Cathy A Walters | Specialist/Technologist | 532 Osuna Rd Ne, Albuquerque, NM 87113 | 2016-04-09 |
| 1518389824 | Esther Sanchez | Home Health Aide | 6800 Vista Del Norte Drive, 2814, Albuqerque, NM 87113 | 2014-01-07 |
| 1356775456 | Danielle Juliet Fichera | Social Worker | 315 Alameda Park Dr, Ne, Albuquerque, NM 87113 | 2013-08-26 |
| 1093053340 | Eagle Pointe Dentists and Orthodontics, LLC | Dentist | 6230 Paseo Del Norte Ne, Suite B, Albuquerque, NM 87113 | 2013-01-22 |
| 1922346428 | Keith Levitt | Anesthesiology | 8100 Wyoming Blvd Ne #712, Suite M4, Albuquerque, NM 87113 | 2013-01-18 |
| Find all providers in zip 87113 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497354328 | Tracy Bui | Nurse Practitioner | 9200 Timber Ridge Rd Nw, Albuquerque, NM 87120-6278 | 2020-10-21 |
| 1558969253 | Beverly Carter | Nurse Practitioner | 5021 Nelson Pl Nw, Albuquerque, NM 87114-4320 | 2020-10-14 |
| 1932706223 | Rozita Dayani | Nurse Practitioner | 6821 Promenade Ave Ne, Albuquerque, NM 87109-2824 | 2020-10-08 |
| 1730795626 | Jia Wu | Nurse Practitioner | 7124 Marseille Pl Ne, Albuquerque, NM 87122-3328 | 2020-09-17 |
| 1912513870 | Ariel A Nunez | Nurse Practitioner | 500 Walter Street Ne, Suite 216, Lovelace Medical Towers - Clinical Informatics, Albuquerque, NM 87102-2543 | 2020-09-16 |
| 1326652173 | Matthew S Fogel | Nurse Practitioner | 3129 Casa Bonita Dr Ne, Albuquerque, NM 87111-5607 | 2020-08-31 |
| 1467065532 | Amberleigh Morrish | Nurse Practitioner | 2100 George Rd Se # 19012, Albuquerque, NM 87106-5608 | 2020-08-28 |
| 1457962102 | Roxanne Christian | Nurse Practitioner | 1909 Brookhaven Pl Nw, Albuquerque, NM 87120-8006 | 2020-08-14 |
| 1689298879 | Marissa Jenee Simpson | Nurse Practitioner | 4839 Stafford Pl Nw, Albuquerque, NM 87120-3232 | 2020-06-03 |
| 1306465810 | Alice Xiao Arellano | Nurse Practitioner | 13512 Red Yucca Ave Ne, Albuquerque, NM 87111-8226 | 2020-04-14 |
| Find all providers in ALBUQUERQUE | ||||
| City | ALBUQUERQUE |
| Zip Code | 87113 |
Please comment or provide details below to improve the information on MR. MICHAEL ALAN 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.