MARTY DALE WALLACE


Address: 1114 Sunset Dr, Suite 4, Johnson City, TN 37604-2969
Phone: 4232830776

MARTY DALE WALLACE (NPI# 1164674743) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1164674743
Entity Type Individual
Full Name MARTY DALE WALLACE
Credential CRNA
Practice Address 1114 Sunset Dr
Suite 4
Johnson City
TN 37604-2969
Mailing Address Po Box 3727
Johnson City
TN 37602-3727
Practice Telephone 4232830776
Practice Fax Number 4232830549
Mailing Telephone 4232830776
Mailing Fax Number 4232830549
Enumeration Date 2008-10-15
Last Update Date 2009-11-20
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 367500000X Nurse Anesthetist, Certified Registered APN13700 TN Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
TN 1510077 05

Other Providers MARTY WALLACE

NPI Name Taxonomy Address Enumeration
1750312344 Marty Green Wallace Family Medicine 415 Devonia Street, Suite 101, Harriman, TN 37748 2006-07-05

Office Location

Street Address 1114 SUNSET DR
SUITE 4
City JOHNSON CITY
State TN
Zip Code 37604-2969

Providers in the same location

NPI Name Taxonomy Address Enumeration
1831195742 Robert L Ashburn Anesthesiology 1114 Sunset Dr, Ste 4, Johnson City, TN 37604-2969 2005-06-24
1902342009 Aging Assistance & Support LLC In Home Supportive Care 1114 Sunset Dr, Suite 3, Johnson City, TN 37604-2969 2017-01-12
1730338740 Nora Nery Manalo Anesthesiology 1114 Sunset Dr, Suite 4, Johnson City, TN 37604-2969 2008-09-15
1265562144 Shelley J Kudialis Nurse Anesthetist, Certified Registered 1114 Sunset Dr, Suite 4, Johnson City, TN 37604-2969 2007-03-07
1093859381 Christopher S Golden Nurse Anesthetist, Certified Registered 1114 Sunset Dr, Suite 4, Johnson City, TN 37604-2969 2007-02-19
1356361687 Kiran M Deshmukh Anesthesiology 1114 Sunset Dr, Suite 4, Johnson City, TN 37604-2969 2006-07-20
1174508964 Dan H Branon Nurse Anesthetist, Certified Registered 1114 Sunset Dr, Suite 4, Johnson City, TN 37604-2969 2005-12-14
1710970850 Ladon W Russell Nurse Anesthetist, Certified Registered 1114 Sunset Dr, Suite 4, Johnson City, TN 37604-2969 2005-08-24
1831182914 Nancy L Stitt Nurse Anesthetist, Certified Registered 1114 Sunset Dr, Suite 4, Johnson City, TN 37604-2969 2005-08-24
1518959956 Marianne Organt Nurse Anesthetist, Certified Registered 1114 Sunset Dr, Suite 4, Johnson City, TN 37604-2969 2005-08-22
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1417560707 Brant Logan Nickens Physical Therapist 809 Lamont St and Veterans Way, Johnson City, TN 37604 2020-08-26
1952911562 David Sandlin Hobbs Pharmacist Lamont St &, Veterans Way, Johnson City, Tn 37604, Johnson City, TN 37604 2020-08-07
1528688272 Whitney Marie Ward Physical Therapist Lamont Street and Veterans Way, Johnson City, TN 37604 2020-04-23
1861050015 Akesh Thomas Student in an Organized Health Care Education/Training Program Johnson City Medical Center, 400 N State of Franklin Rd, Johnson City, TN 37604 2019-06-03
1336629021 Medical Education Assistance Corporation Clinic/Center 820 W Market St, Johnson City, TN 37604 2018-08-21
1093208951 Lauren Tiffany Hayden Physician Assistant 403 N State of Franklin Rd Woodridge Hospital, Johnson City, TN 37604 2018-06-14
1174014450 Jerica Moore Specialist/Technologist 1041 Hamiltion Place Dr., Johnson City, TN 37604 2018-05-23
1053809442 Syed Ghazanfar Hasan Student in an Organized Health Care Education/Training Program Etsu Psychiatry and Behavioral Sciences Department, 1276 Gilbreath Dr., Johnson City, TN 37604 2018-05-01
1699262485 Sonia Kumari Oad Student in an Organized Health Care Education/Training Program 178 West Maple St, Johnson City, TN 37604 2018-04-17
1821519364 Mahmoud El Iskandarani Internal Medicine 1084 W Oakland Avenue, 748, Johnson City, TN 37604 2017-07-06
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Taxonomy Information

Taxonomy Code 367500000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Anesthetist, Certified Registered

Taxonomy Definition

(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.
Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1033358544 Marcos D Demoura Nurse Anesthetist, Certified Registered 818 Sunset Dr Ste 103, Johnson City, TN 37604-8310 2009-02-09
1750399127 Anesthesia and Pain Consultants,p.c. Nurse Anesthetist, Certified Registered 1009 Lark St Ste 2, Johnson City, TN 37604-8218 2006-08-03
1669493243 Margaret Rachel Weston Nurse Anesthetist, Certified Registered Corner of Sydney and Lamont, Johnson City, TN 37684 2006-07-21
1093795098 Ling-ling Shih Nurse Anesthetist, Certified Registered 156 Corliss Ave, Suite 107, Johnson City, NY 13790-2060 2006-01-18
1366444028 Ruben Fuentes Nurse Anesthetist, Certified Registered 1111 Sunset Dr, Suite 4, Johnson City, TN 37604-3615 2005-08-12
1811510993 Susan Cronier Nurse Anesthetist, Certified Registered 400 N State of Franklin Rd, Johnson City, TN 37604-6035 2020-05-22
1235760422 William James Brant Nurse Anesthetist, Certified Registered 400 N State of Franklin Rd, Johnson City, TN 37604-6035 2020-01-28
1235769605 Ryan T Pickett Nurse Anesthetist, Certified Registered 57 N Harrison St, Johnson City, NY 13790-1476 2020-01-24
1063970580 Todd M Kubesh Nurse Anesthetist, Certified Registered 57 N Harrison St, Johnson City, NY 13790-1476 2019-03-04
1922565001 Matthew S Fabian Nurse Anesthetist, Certified Registered 57 N Harrison St, Johnson City, NY 13790-1476 2019-02-26
Find all providers in JOHNSON CITY

Competitor

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City JOHNSON CITY
Zip Code 37604

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Dataset Information

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.

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