JUSTIN COVEY WALLACE (NPI# 1578807103) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578807103 |
| Entity Type | Individual |
| Full Name | JUSTIN COVEY WALLACE |
| Credential | RN |
| Practice Address |
4212 N 16th St Phoenix AZ 85016-5319 |
| Mailing Address |
13126 N 154th Ave Surprise AZ 85379-9150 |
| Practice Telephone | 6022631200 |
| Enumeration Date | 2012-11-20 |
| Last Update Date | 2012-11-20 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WE0003X |
Registered Nurse Specialization: Emergency |
RN173423 | AZ | Nursing Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417331679 | Justin Matthew Wallace | Marriage & Family Therapist | 1322 E Shaw Ave Ste 410, Fresno, CA 93710-7904 | 2015-07-16 |
| 1649609728 | Justin K Wallace | Veterinarian | 120 S 6th St, Chickasha, OK 73018-3420 | 2013-11-08 |
| 1114354156 | Justin Cory Wallace | Military Health Care Provider | 699 14th St, San Diego, CA 92101-7586 | 2013-10-06 |
| 1033372594 | Justin Robert Wallace | Surgery | 530 South St, Suite 380, Greensburg, PA 15601-2775 | 2008-07-05 |
| Street Address |
4212 N 16TH ST |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85016-5319 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184627648 | Judy Marie Pinsonneault | Family Medicine | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2005-05-27 |
| 1568071348 | Christopher Tran | Pharmacist | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2020-07-28 |
| 1659980480 | Corinne Easterling | Pharmacist | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2020-07-28 |
| 1598383192 | Tamika Howard | Pharmacist | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2020-07-09 |
| 1659901544 | Joseph Maloy | Pharmacist | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2020-01-20 |
| 1437709680 | Kymberly Sue Ludwig | Pharmacist | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2019-09-18 |
| 1962052746 | Jamie C Wilson | Registered Nurse | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2019-09-13 |
| 1427602721 | Jonathon Andrew Marquez | Respiratory Therapist, Certified | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2019-07-25 |
| 1700441664 | Douglas Edward Henry | Physical Therapist | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2019-05-07 |
| 1982189205 | Rachael Renina Hunter Edwards | Psychologist | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2018-10-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851992705 | Heatheranne Baker-oldfield | Counselor | 2415 E Camelback Rd Ste 700, Phoenix, AZ 85016 | 2020-11-06 |
| 1780215681 | Sip Home Systems - Mesa LLC | Home Health | 24th At Camelback, 2375 E. Camelback Rd., Suite 600, Phoenix, AZ 85016 | 2020-01-29 |
| 1760945588 | Wei Wei | Student in an Organized Health Care Education/Training Program | Phoenix Children's Hospital 1919 E. Thomas Rd., Phoenix, AZ 85016 | 2019-04-09 |
| 1942765623 | Grace Hatfield | Dietitian, Registered | Phoenix Childrens Hospital 1919 E Thomas Rd, Phoenix, AZ 85016 | 2019-02-06 |
| 1861977027 | Dawn Yvette Lima | Occupational Therapy Assistant | 3128 E Cheery Ln, Phoenix, AZ 85016 | 2018-10-03 |
| 1720583685 | Kristin Pauline Hicklin | Registered Nurse | 2930 E Camelback Rd Ste 100, Phoenix, AZ 85016 | 2018-03-24 |
| 1588181622 | Taness Eyre Billington | Pharmacist | 1625 E. Camelback Rd., Phoenix, AZ 85016 | 2017-08-29 |
| 1093239048 | Emma Ross | Psychologist | 1919 E Thomas Rd Bldg 4th, Phoenix, AZ 85016 | 2017-08-01 |
| 1609396985 | Mohammed Waseemuddin | Student in an Organized Health Care Education/Training Program | Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016 | 2017-06-27 |
| 1144777632 | Amanda Mazerall | Occupational Therapist | 4333 N 24th Street, Apartment 223, Phoenix, AZ 85016 | 2016-09-01 |
| Find all providers in zip 85016 | ||||
| Taxonomy Code | 163WE0003X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Emergency |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093957151 | Melissa Dibble | Registered Nurse | 18250 N Cave Creek Rd Unit 191, Phoenix, AZ 85032-1048 | 2009-04-03 |
| 1609406362 | Jessica Martin | Registered Nurse | 650 E Indian School Rd, Phoenix, AZ 85012-1839 | 2020-01-22 |
| 1720545734 | Joshua David Stark | Registered Nurse | 350 W Thomas Rd, Phoenix, AZ 85013-4496 | 2019-02-26 |
| 1922592724 | Paloma Veleta | Registered Nurse | 6601 W Thomas Rd, Phoenix, AZ 85033-5700 | 2018-06-15 |
| 1073003059 | Katie Rose Vogan | Registered Nurse | 2375 E Camelback Rd Ste 600, Phoenix, AZ 85016-3493 | 2018-05-15 |
| 1811491095 | Susan Ann Mcnulty | Registered Nurse | 650 E Indian School Rd, Phoenix, AZ 85012-1839 | 2018-03-21 |
| 1518411222 | Mikala Renee Bliss | Registered Nurse | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2016-08-10 |
| 1598115065 | Trinity Taylor Barnes | Registered Nurse | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2016-06-15 |
| 1609245281 | Alysia Maryn Cardona | Registered Nurse | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2015-09-24 |
| 1487030557 | James Hodlofski | Registered Nurse | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2015-07-30 |
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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.