MS. TINA WALLACE (NPI# 1326484056) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326484056 |
| Entity Type | Individual |
| Full Name | MS. TINA WALLACE |
| Practice Address |
4603 40th Ave Kenosha WI 53144-3543 |
| Practice Telephone | 2629141981 |
| Mailing Telephone | 2629141981 |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2013-05-21 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 164X00000X | Licensed Vocational Nurse | 31662-31 | WI | Nursing Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881234219 | Tina Gayle Wallace | Licensed Vocational Nurse | 755 S Beckham Ave, Tyler, TX 75701-1903 | 2020-01-14 |
| 1285271254 | Tina Marie Wallace | Optometrist | 1363 Veterans Memorial Hwy Ste 8, Hauppauge, NY 11788-3046 | 2019-12-09 |
| 1093846826 | Tina Wallace | Case Manager/Care Coordinator | 1815 Stockton Blvd, Sacramento, CA 95816-6653 | 2007-03-07 |
| Street Address |
4603 40TH AVE |
| City | KENOSHA |
| State | WI |
| Zip Code | 53144-3543 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902410202 | Dpt Holdings LLC | Occupational Therapist | 3825 39th Ave #110, Kenosha, WI 53144 | 2020-09-03 |
| 1225641392 | Eunice Boatin | Social Worker | Kenosha Human Development Services, 3536 52nd Street, Kenosha, WI 53144 | 2020-08-28 |
| 1881250256 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 3621 Market Lane, Kenosha, WI 53144 | 2019-05-11 |
| 1124540067 | Kaitlyn King | Speech-Language Pathologist | 5219 88th Ave., Kenosha, WI 53144 | 2017-07-12 |
| 1174992721 | Claire Ann Adams | Acupuncturist | 5416 52nd Street, Kenosha, WI 53144 | 2015-09-24 |
| 1285017087 | Jessica Lynn Gillengerten | Acupuncturist | 4235 Green Bay Rd., Suite #10, Kenosha, WI 53144 | 2015-06-30 |
| 1750704656 | Amanda Kay Kreuzer | Occupational Therapy Assistant | 3109 30th Ave, Kenosha, WI 53144 | 2014-01-28 |
| 1841626785 | B7 Pharmacy Inc | Pharmacy | 3825 39th Ave Ste 100, Kenosha, WI 53144 | 2013-09-24 |
| 1124326764 | Wisconsin Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 3710 57th Ave, Kenosha, WI 53144 | 2011-03-07 |
| 1982931291 | Roman Bilak | General Practice | 4126 - 7th Street, Kemosha, WI 53144 | 2009-11-06 |
| Find all providers in zip 53144 | ||||
| Taxonomy Code | 164X00000X |
| Grouping | Nursing Service Providers |
| Classification | Licensed Vocational Nurse |
| An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. [An alternate term for licensed practical nurse arising from difference in occupational titles between states and post-high school training programs and institutions.] Requirements for education, experience, licensure, and job responsibilities vary among the states. |
| Notes: Source: Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740798040 | Landra Monique Brown | Licensed Vocational Nurse | 7608 W Waterford Ave, Milwaukee, WI 53220-2235 | 2018-01-21 |
| 1780191916 | Lucie Toczyl | Licensed Vocational Nurse | 3742 E Whittaker Ave, Cudahy, WI 53110-1150 | 2018-01-09 |
| 1447704101 | Keisha Moore | Licensed Vocational Nurse | 8048 N Celina St, Milwaukee, WI 53224-2904 | 2016-08-11 |
| 1962871319 | Michelle Sondreal | Licensed Vocational Nurse | 5512 Broadhead St, Mc Farland, WI 53558-9603 | 2015-09-16 |
| 1396128559 | Desiree Rafel | Licensed Vocational Nurse | 3233 W Colony Dr, Greenfield, WI 53221-2110 | 2015-07-07 |
| 1841545373 | Hady Ndiaye | Licensed Vocational Nurse | 3138 N 89th Street, Milwaukee, WI 53222-5503 | 2012-07-20 |
| 1932466307 | April Weis | Licensed Vocational Nurse | 124 N 9th Ave, Wausau, WI 54401-4323 | 2012-04-23 |
| 1578846010 | Patricia Ann Sheets | Licensed Vocational Nurse | 316 N. Terrace St., Janbesville, WI 53548 | 2011-09-21 |
| 1417280074 | Herlinda M Rios | Licensed Vocational Nurse | 6100 W. State Street, #624, Wauwatosa, WI 53213-2993 | 2009-09-15 |
| 1053544304 | Elizabeth Diane Nelson | Licensed Vocational Nurse | 924 S 74th St, West Allis, WI 53214-3003 | 2009-09-02 |
| Find all providers with the same taxonomy | ||||
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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.