MARY MICHELLE WALLACE (NPI# 1417176546) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417176546 |
| Entity Type | Individual |
| Full Name | MARY MICHELLE WALLACE |
| Credential | N.P. |
| Practice Address |
444 N 44th St #200 Phoenix AZ 85008-7624 |
| Practice Telephone | 6026853846 |
| Practice Fax Number | 6026853808 |
| Mailing Telephone | 6026853846 |
| Mailing Fax Number | 6026853808 |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
RN030118 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 637184 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528585031 | Mary Wallace | Psychologist | 1605 E Ash St, Canton, IL 61520-1510 | 2017-08-25 |
| 1801136809 | Mary Etheridge Wallace | Counselor | 303 E. Main Street Suite 9, Elizabeth City, NC 27909 | 2013-02-27 |
| 1851541163 | Mary Caroline Wallace | Speech-Language Pathologist | 5 5th St Se, Washington, DC 20003-1119 | 2008-09-23 |
| 1245446723 | Mary Frances Wallace | Massage Therapist | 3301 River Ave, Huntington, WV 25705-2807 | 2007-05-14 |
| 1134253396 | Mary Beth Wallace | Speech-Language Pathologist | 2461 Highway 1, Harrisburg, AR 72432-9479 | 2007-03-16 |
| 1619045648 | Mary D Wallace | Social Worker | 105 Broadview Dr, Syracuse, NY 13215-1505 | 2006-11-30 |
| 1013451608 | Mary Elise Wallace | Dietitian, Registered | 3600 Gaston Ave, Suite 656, Dallas, TX 75246-1800 | 2016-12-15 |
| 1982156766 | Mary Terese Wallace | Dietitian, Registered | 700 Broadway, Seattle, WA 98122-4302 | 2016-10-27 |
| 1194173443 | Mary Wallace | Case Manager/Care Coordinator | 627 S Elliott Ave, Wenatchee, WA 98801-3195 | 2016-05-27 |
| 1255760898 | Mary Wallace | Counselor | 1818 Se Division St, Portland, OR 97202-1159 | 2013-11-04 |
| Street Address |
444 N 44TH ST #200 |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85008-7624 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659307668 | Gregory L Gale | Psychiatry & Neurology | 444 N 44th St, #400, Phoenix, AZ 85008-7624 | 2006-06-23 |
| 1952593618 | Clifford Simske | Psychiatry & Neurology | 444 N 44th St, Phoenix, AZ 85008-7624 | 2007-08-15 |
| 1538368717 | Suhaila G Al Haddad | Psychiatry & Neurology | 444 N 44th St, #400, Phoenix, AZ 85008-7624 | 2007-07-17 |
| 1194923110 | Sead Hadziahmetovic | Psychiatry & Neurology | 444 N 44th St, #400, Phoenix, AZ 85008-7624 | 2007-07-11 |
| 1356549281 | Arnold L Kendall | Psychiatry & Neurology | 444 N 44th St, #400, Phoenix, AZ 85008-7624 | 2007-07-03 |
| 1962608430 | James M Donahue | Psychiatry & Neurology | 444 N 44th St, #400, Phoenix, AZ 85008-7624 | 2007-06-22 |
| 1457556284 | Easwar Bhoothalingom | Psychiatry & Neurology | 444 N 44th St, #400, Phoenix, AZ 85008-7624 | 2007-06-20 |
| 1518160753 | Cornell V Jones | Psychiatry & Neurology | 444 N 44th St, #400, Phoenix, AZ 85008-7624 | 2007-06-06 |
| 1407058290 | Bahram Taghavi | Psychiatry & Neurology | 444 N 44th St, #400, Phoenix, AZ 85008-7624 | 2007-06-04 |
| 1891908570 | Gary J Mihalik | Psychiatry & Neurology | 444 N 44th St, #400, Phoenix, AZ 85008-7624 | 2007-05-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821607060 | Am Apnea and Tmj LLC | Durable Medical Equipment & Medical Supplies | 2303 N. 44thst., Suite 14-1008, Phoenix, AZ 85008 | 2020-07-23 |
| 1194341131 | Abdulbaril Olandapo Olagunju | Student in an Organized Health Care Education/Training Program | 2601 E Roosevelt Street, Valleywise Health, Phoenix, AZ 85008 | 2020-06-24 |
| 1376164632 | Abdul Rahman Raed Mustafa Halawa | Student in an Organized Health Care Education/Training Program | 2601 E Roosevelt St Valleywise Health, Phoenix, AZ 85008 | 2020-04-28 |
| 1245869460 | Zachary Masuda | Student in an Organized Health Care Education/Training Program | Valleywise Health Medical Center, 2601 E Roosevelt St, Phoenix, AZ 85008 | 2020-04-08 |
| 1942840145 | Cana Behavior LLC | Physical Therapist | 2412 N 36 Pl, Phoenix, AZ 85008 | 2020-01-15 |
| 1871158188 | Fred Gardezy | Student in an Organized Health Care Education/Training Program | Maricopa Integrated Health System 2601 E. Roosevelt St., Phoenix, AZ 85008 | 2019-05-02 |
| 1225692346 | Navkaran Singh Girgla | Student in an Organized Health Care Education/Training Program | 2601 East Roosevelt St., Phoenix, AZ 85008 | 2019-04-24 |
| 1316412323 | Southwest Human Developement | Early Intervention Provider Agency | 2850 N 24h Street, Phoenix, AZ 85008 | 2018-10-05 |
| 1558885970 | Mona Ridhwan Ziems | Midwife | 1919 N 31st St, Phoenix, AZ 85008 | 2017-07-27 |
| 1093244451 | Shana Cynamon | Audiologist | 1801 N 37th Pl, Phoenix, AZ 85008 | 2017-06-08 |
| Find all providers in zip 85008 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215536479 | Yolanda D Baugh | Nurse Practitioner | 2625 W Piedmont Rd, Phoenix, AZ 85041-9540 | 2020-10-20 |
| 1306450960 | Williamsconsultant Com LLC | Nurse Practitioner | 2303 N 44th St Ste 12-1043, Phoenix, AZ 85008-2442 | 2020-09-01 |
| 1912515305 | Victory Health Solution LLC | Nurse Practitioner | 9132 W Hubbell St, Phoenix, AZ 85037-4377 | 2020-07-21 |
| 1700494374 | Vanessa Moe | Nurse Practitioner | 42949 N Voyage Trl, Phoenix, AZ 85086-8040 | 2020-07-20 |
| 1043838527 | Latasha Lynne Freeman | Nurse Practitioner | 1919 E Thomas Rd Bldg 5th, Phoenix, AZ 85016-7710 | 2020-07-10 |
| 1861019416 | Gayle Cecilia Bachelier | Nurse Practitioner | 2302 N Central Ave Unit 303, Phoenix, AZ 85004-1373 | 2020-06-30 |
| 1871119156 | Ashlyn Tellers | Nurse Practitioner | 21438 N 33rd Ave, Phoenix, AZ 85027-2241 | 2020-06-22 |
| 1770109605 | Hannah Carita Jurekovic-byrd | Nurse Practitioner | 5727 N 7th St Ste 308, Phoenix, AZ 85014-5817 | 2020-06-16 |
| 1578188025 | Joseph Medlin | Nurse Practitioner | 915 N 52nd St Apt 2010, Phoenix, AZ 85008-7934 | 2020-06-10 |
| 1750901088 | Foothills Psychiatric Services Pllc | Nurse Practitioner | 3546 E Windmere Dr, Phoenix, AZ 85048-7211 | 2020-04-16 |
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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.