DONNA M WALLACE (NPI# 1154577047) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154577047 |
| Entity Type | Individual |
| Full Name | DONNA M WALLACE |
| Credential | ARPN |
| Practice Address |
46 Albion St Bridgeport CT 06605-2602 |
| Mailing Address |
46 Albion St Southwest Community Health Center, Inc Bridgeport CT 06605-2602 |
| Practice Telephone | 2033306000 |
| Practice Fax Number | 2033306007 |
| Mailing Telephone | 2033323155 |
| Mailing Fax Number | 2033306008 |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2014-08-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
003840 | CT | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | STATE LICENSE 003840 | 003840 | 01 |
| CT | 004236130 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164938130 | Donna C. Wallace | Pharmacist | 1817 Nw 127th Ave, Pembroke Pines, FL 33028-2567 | 2017-12-28 |
| 1710199328 | Donna Wallace | Social Worker | 2110 Sw 97 Lane, Davie, FL 33324 | 2007-05-04 |
| 1639558471 | Donna Wallace | Counselor | 2814 S Us Highway 1, Suite D-4, Fort Pierce, FL 34982-8120 | 2015-05-26 |
| 1932475977 | Donna Lee Wallace | Specialist | 5600 Cypresswood Dr, Spring, TX 77379-8260 | 2012-03-23 |
| 1003016320 | Donna K Wallace | Counselor | 1901 S 24th Ave, Edinburg, TX 78539-6533 | 2007-07-24 |
| 1386792349 | Donna M. Wallace | Pathology | 4647 Zion Ave, San Diego, CA 92120-2507 | 2007-01-08 |
| 1124192703 | Donna F Wallace | Physical Therapist | 3445 Post Road, J Arthur Trudeau Memorial Center Attn Kim Ruelle Hr, Warwick, RI 02886-7147 | 2006-11-17 |
| 1952321200 | Donna D Wallace | Nurse Practitioner | 920 E 28th St, Suite 700, Minneapolis, MN 55407-1139 | 2006-07-20 |
| 1346236122 | Donna C Wallace | Nurse Practitioner | 2910 N 3rd Ave, Phoenix, AZ 85013-4434 | 2005-09-27 |
| Street Address |
46 ALBION ST |
| City | BRIDGEPORT |
| State | CT |
| Zip Code | 06605-2602 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801898804 | Jose A Camacho-pantoja | Psychiatry & Neurology | 46 Albion St, Southwest Community Health Center, Inc, Bridgeport, CT 06605-2602 | 2005-08-10 |
| 1790302933 | Kelly Yorio | Nurse Practitioner | 46 Albion St, Bridgeport, CT 06605-2602 | 2020-07-04 |
| 1316564396 | Catherine Marie Howe | Registered Nurse | 46 Albion St, Bridgeport, CT 06605-2602 | 2020-06-25 |
| 1275178261 | Anna Marie Washington | Social Worker | 46 Albion St, Bridgeport, CT 06605-2602 | 2019-11-13 |
| 1144876608 | Jessie Gay | Nurse Practitioner | 46 Albion St, Bridgeport, CT 06605-2602 | 2019-08-12 |
| 1881248136 | Ntohmabi Ndingwan | Nurse Practitioner | 46 Albion St, Bridgeport, CT 06605-2602 | 2019-07-25 |
| 1548813090 | Nikki Marie Carino | Nurse Practitioner | 46 Albion St, Bridgeport, CT 06605-2602 | 2019-07-23 |
| 1235790296 | Hudson I Hector | Dental Hygienist | 46 Albion St, Bridgeport, CT 06605-2602 | 2019-06-20 |
| 1235603044 | Katherine Esaw | Social Worker | 46 Albion St, Bridgeport, CT 06605-2602 | 2019-01-15 |
| 1013484088 | Samantha Mraz | Nurse Practitioner | 46 Albion St, Bridgeport, CT 06605-2602 | 2018-10-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497312276 | Stacy-ann Thompson-grant | Social Worker | 170 Bennet T Street, Bridgeport, CT 06605 | 2019-05-28 |
| 1720502149 | Sheree Amankwah | Counselor | 170 Bennett Street, Bridgeport, CT 06605 | 2017-07-27 |
| 1417477324 | Aracelis Robertson | Case Manager/Care Coordinator | 1646 Fairfield Avenue, 3rd Floor, Bridgeport, CT 06605 | 2017-06-21 |
| 1699158170 | Cortney Davis | Physician Assistant | 3250 Fairfield Ave, Unit 217, Bridgeport, CT 06605 | 2015-07-02 |
| 1083020051 | Douglas Mccoy | Nurse Practitioner | 46 Albion St., Bridgeport, CT 06605 | 2014-07-10 |
| 1932513785 | Hallie Claire Riggs | Social Worker | 1730 State St Ext, Bridgeport, CT 06605 | 2014-06-19 |
| 1831518513 | Yvonne Booy | Counselor | 46 Albion Street, Bridgeport, CT 06605 | 2014-04-10 |
| 1760556955 | Joel W Allen | Obstetrics & Gynecology | 625 Clinton Ave, Bridgeport, CT 06605 | 2006-11-20 |
| 1316046428 | Allen P Schlein | Orthopaedic Surgery | 650 Clinten Avenue, Bridgeport, CT 06605 | 2006-09-22 |
| 1336127984 | Hancock Pharmacy | Pharmacy | 1557 Fairfield Ave, Bridgeport, CT 06605 | 2006-01-04 |
| Find all providers in zip 06605 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861915019 | Stephanie Jean Fluharty | Nurse Practitioner | 1511 Johnson Ave Ste 104, Bridgeport, WV 26330-1016 | 2017-07-19 |
| 1730601006 | Katherine Smith Carter | Nurse Practitioner | 68 Woodland Ave, Bridgeport, CT 06605-3457 | 2017-07-08 |
| 1285186148 | Helen Leahy | Nurse Practitioner | 439 Mill Hill Ave., Bridgeport, CT 06610 | 2016-10-26 |
| 1588119408 | Lisa M Finoia | Nurse Practitioner | 2800 Main St Fl 3, Bridgeport, CT 06606-4201 | 2016-08-20 |
| 1437568003 | Donte Jamal Newsom | Nurse Practitioner | 1370 Johnson Ave Ste 202, Bridgeport, WV 26330-1378 | 2014-08-08 |
| 1053675033 | Joanna R Fernandez | Nurse Practitioner | 500 Palisade Ave, Bridgeport, CT 06610-3458 | 2012-06-25 |
| 1558678623 | Dermatology Outreach, LLC | Nurse Practitioner | 111 State St., Bridgeport, WV 26330 | 2010-09-09 |
| 1659546109 | Christine Margaret Berte | Nurse Practitioner | 790 Fairfield Ave, Bridgeport, CT 06604-3701 | 2008-04-25 |
| 1043383508 | Susan Flanigan Bates | Nurse Practitioner | Mcmwtc Bldg 3005, Hc 83 Box 1, Bridgeport, CA 93517 | 2006-11-15 |
| 1629048418 | Renee Biehl | Nurse Practitioner | 761 Lindley St, Bridgeport, CT 06606-5043 | 2006-01-24 |
| Find all providers in BRIDGEPORT | ||||
| City | BRIDGEPORT |
| Zip Code | 06605 |
Please comment or provide details below to improve the information on DONNA M 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.