TRESA C WALLACE


Address: 110 Bellemeade Blvd., Suite A, Gretna, LA 70056-2954
Phone: 5043092576

TRESA C WALLACE (NPI# 1245673565) 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) 1245673565
Entity Type Individual
Full Name TRESA C WALLACE
Credential WHNP
Practice Address 110 Bellemeade Blvd.
Suite A
Gretna
LA 70056-2954
Mailing Address 100 Orange Blossom Ct
Belle Chasse
LA 70037-1649
Practice Telephone 5043092576
Practice Fax Number 5043092589
Mailing Telephone 5047820673
Enumeration Date 2013-04-17
Last Update Date 2020-07-24
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LX0001X Nurse Practitioner
Specialization: Obstetrics & Gynecology
AP07277 LA Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 110 BELLEMEADE BLVD.
SUITE A
City GRETNA
State LA
Zip Code 70056-2954

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1023634169 Krewe Wellness Counselor 2112 Belle Chasse Hwy Ste 8, #156, Gretna, LA 70056 2020-06-24
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1558843219 Nikell Thompson Fortia Non-emergency Medical Transport (VAN) 561 Morningside Dr, Gretna, LA 70056 2018-08-29
1861979379 Irajuan L Cooley Case Manager/Care Coordinator 1620 Carol Sue Ave Apt 219, Gretna, LA 70056 2018-07-26
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1184126278 Elesha Loston Case Manager/Care Coordinator 1799 Stumpf Blvd. Bldg .7 Suite 9a, Gretna, LA 70056 2018-03-05
1336656149 Porsha D Causey Counselor 1799 Stumpf Blvd Bldg 7 Ste 10, Ste 10, Gretna, LA 70056 2018-01-02
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Taxonomy Information

Taxonomy Code 363LX0001X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Obstetrics & Gynecology

Taxonomy Definition

Definition to come...

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1548678188 Joanna Poole Nurse Practitioner 2120 Bert Kouns Industrial Loop Ste A, Shreveport, LA 71118-3351 2014-07-28
1730590712 Stacy Davis Nurse Practitioner 71380 Highway 21 Ste 101, Covington, LA 70433-7245 2014-05-13
1942433438 Rebecca Reason Breaux Nurse Practitioner 180 Infirmary Rd, Baton Rouge, LA 70803-0001 2009-08-31
1275672909 Patsy H Mcclanahan Nurse Practitioner 3326 Front St Ste B, Winnsboro, LA 71295-6487 2007-02-06
1164515169 Jennifer Allen Long Nurse Practitioner 2400 Hospital Dr Ste 400, Bossier City, LA 71111-2401 2006-10-02
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1417262361 Casey Dufrene Pech Nurse Practitioner 406 N Acadia Rd, Thibodaux, LA 70301-4856 2010-08-16
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Competitor

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City GRETNA
Zip Code 70056

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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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