LEONTINE WALLACE (NPI# 1053800649) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053800649 |
| Entity Type | Individual |
| Full Name | LEONTINE WALLACE |
| Credential | RN, BSN |
| Practice Address |
2300 Haggerty Rd Ste 2110 West Bloomfield MI 48323-2191 |
| Practice Telephone | 2489261420 |
| Practice Fax Number | 2489265338 |
| Mailing Telephone | 2489261420 |
| Mailing Fax Number | 2489265338 |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2018-05-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WL0100X |
Registered Nurse Specialization: Lactation Consultant |
4704318023 | MI | Nursing Service Providers |
| N | 163WP0200X |
Registered Nurse Specialization: Pediatrics |
4704318023 | MI | Nursing Service Providers |
| Street Address |
2300 HAGGERTY RD STE 2110 |
| City | WEST BLOOMFIELD |
| State | MI |
| Zip Code | 48323-2191 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235503301 | James K. Uhes | Occupational Therapist | 2300 Haggerty Rd. Ste 2190, Lakes Medical Center, West Bloomfield, MI 48323 | 2015-11-30 |
| 1700253283 | Max Elder | Specialist/Technologist | 2387 Scotch Pine St, West Bloomfield, MI 48323 | 2015-08-31 |
| 1952792400 | Michael Cataldo | Technician, Other | 6626 Torybrooke Ct, West Bloomfield, MI 48323 | 2015-02-05 |
| 1982944666 | Steven Nathan Rives | Internal Medicine | 2300 Haggerty Rd Ste 2060, West Bloomfield, MI 48323 | 2013-02-18 |
| 1275871832 | Detroit Medical Center Sinai Grace Hospital | General Acute Care Hospital | 3495 Pine Estates Drive, West Bloomfield, MI 48323 | 2013-01-16 |
| 1295090793 | Advance Health Care System, LLC | Massage Therapist | 4267 Foxpoint, West Bloomfield, MI 48323 | 2012-07-10 |
| 1841566700 | Eduardo Rivera | Pathology | 2920 Bloomfield Shore Drive, West Bloomfield, MI 48323 | 2012-03-26 |
| 1952611782 | Debra Mary Gregory PC LLC | Social Worker | 7130 Walnut Lake Road, West Bloomfield, MI 48323 | 2010-10-14 |
| 1033362793 | Alvin Yousif Daboul | Dentist | 2332 Hiller Road, West Bloomfield, MI 48323 | 2008-10-28 |
| 1386846574 | Jerald B Maltzman | Radiology | 4744 Wendrick Dr, W. Bloomfield, MI 48323 | 2007-06-01 |
| Find all providers in zip 48323 | ||||
| Taxonomy Code | 163WL0100X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Lactation Consultant |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790392959 | Theresa Hope Madoun | Registered Nurse | 3362 Parkland Dr, West Bloomfield, MI 48322-1828 | 2020-09-30 |
| 1033604533 | Maja Cerimagic | Registered Nurse | 6777 W Maple Rd, West Bloomfield, MI 48322-3013 | 2018-06-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447851183 | Cynthia Jean Werner | Registered Nurse | 70067 Beach Dr, Edwardsburg, MI 49112-8434 | 2020-11-07 |
| 1609491133 | Rebecca Shanahan | Registered Nurse | 3489 W River Rd, Muskegon, MI 49445-9606 | 2020-06-10 |
| 1841814456 | Tara Roberta Sullivan | Registered Nurse | 24808 Boston St, Dearborn, MI 48124-4411 | 2020-05-31 |
| 1861031957 | Rebecca Taylor | Registered Nurse | 3150 Livernois Rd Ste 175, Troy, MI 48083-5058 | 2020-01-06 |
| 1275174484 | Micia Jena Eddins | Registered Nurse | 4217 Aretha Ave, Detroit, MI 48201-1556 | 2019-09-30 |
| 1790248854 | Lactation Home Support LLC | Registered Nurse | 1218 S Forest Dr, Muskegon, MI 49442-4814 | 2019-04-07 |
| 1386119477 | Lisa Marie Levy | Registered Nurse | 520 N Silvery Ln, Dearborn, MI 48128-1538 | 2018-10-04 |
| 1932680717 | Barbara Danielle Demske | Registered Nurse | 269 Roland St, Belleville, MI 48111-2742 | 2018-08-28 |
| 1588162200 | Linda Kay Gewirtz | Registered Nurse | 223 E Clinton St, Ovid, MI 48866-9704 | 2018-01-28 |
| 1679096374 | Rebecca Campau | Registered Nurse | 4985 Lakeshore Rd, Fort Gratiot, MI 48059 | 2017-07-25 |
| Find all providers with the same taxonomy | ||||
| City | WEST BLOOMFIELD |
| Zip Code | 48323 |
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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.