MR. ROBERT ERIC WALLACE (NPI# 1720007156) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720007156 |
| Entity Type | Individual |
| Full Name | MR. ROBERT ERIC WALLACE |
| Credential | APN |
| Practice Address |
1 University Cir Macomb IL 61455-1367 |
| Practice Telephone | 3092981888 |
| Practice Fax Number | 3092982188 |
| Mailing Telephone | 3092981888 |
| Mailing Fax Number | 3092982188 |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
IL | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316430176 | Robert E Wallace | Case Manager/Care Coordinator | 283 Old Colliers Way, Weirton, WV 26062-4073 | 2018-06-07 |
| 1801337134 | Robert William Wallace II | Student in an Organized Health Care Education/Training Program | 204 N Silver Maple Dr, Slidell, LA 70458-5483 | 2017-03-20 |
| 1780015610 | Robert G. Wallace | Radiology | 1130 Goat Rock Road, Fortson, GA 31808 | 2013-12-03 |
| 1972947257 | Robert William Wallace | Registered Nurse | 40 Ridge Dr, West Hurley, NY 12491-5627 | 2013-04-17 |
| 1487991683 | Robert J Wallace | Acupuncturist | 1619 W Montrose, Chicago Holistic Medicine, Chicago, IL 60613 | 2013-01-08 |
| 1154582773 | Robert Lee Wallace | Counselor | 110 S Hancock St, Rockingham, NC 28379-3675 | 2008-06-17 |
| 1649484635 | Robert Jay Wallace | Obstetrics & Gynecology | 6250 Alfred Harrell Hwy, Bakersfield, CA 93308-9654 | 2007-05-09 |
| 1023132644 | Robert S Wallace | Chiropractor | 7 Centre Dr, Suite 10, Monroe, NJ 08831-1565 | 2007-03-19 |
| 1750443024 | Robert Wallace | Pharmacist | 12421 W Denton Ave, Litchfield Park, AZ 85340-3435 | 2006-12-14 |
| 1922113174 | Robert Vernon Wallace | Family Medicine | 400 Lee Blvd, Lehigh Acres, FL 33936-4923 | 2006-08-20 |
| Street Address |
1 UNIVERSITY CIR |
| City | MACOMB |
| State | IL |
| Zip Code | 61455-1367 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134193691 | Renee L Polubinsky | Specialist/Technologist | 1 University Cir, Macomb, IL 61455-1367 | 2006-02-13 |
| 1174143408 | Sabrina Kleparski | Specialist/Technologist | 1 University Cir, Macomb, IL 61455-1367 | 2020-04-16 |
| 1376193672 | Provider Connections | Clinic/Center | 1 University Cir, Macomb, IL 61455-1367 | 2019-09-18 |
| 1497212864 | Charnelle Nicole Brinker | Speech-Language Pathologist | 1 University Cir, Macomb, IL 61455-1367 | 2019-02-21 |
| 1790268647 | Thomas Alan Adams | Specialist/Technologist | 1 University Cir, Macomb, IL 61455-1367 | 2018-09-06 |
| 1679091631 | Rowan Paige Haverkamp | Specialist/Technologist | 1 University Cir, Macomb, IL 61455-1367 | 2017-08-30 |
| 1407370729 | Philip Ray Nickols | Specialist/Technologist | 1 University Cir, Macomb, IL 61455 | 2017-07-28 |
| 1457807414 | Tanner Maksymicz | Specialist/Technologist | 1 University Cir, Macomb, IL 61455-1367 | 2016-08-30 |
| 1073964086 | Sabreen Dassa | Developmental Therapist | 1 University Cir, Macomb, IL 61455-1367 | 2016-06-30 |
| 1578953725 | Omaha Vamc | Clinic/Center | 1 University Cir, Macomb, IL 61455-1367 | 2015-01-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043869944 | Wesley Village, Inc | Speech-Language Pathologist | 1200 East Grant Street, Macomb, IL 61455 | 2019-09-04 |
| 1780154013 | Hannah Lauren Bengtson | Optometrist | 820 E. Jackson St., Macomb, IL 61455 | 2018-11-29 |
| 1255832564 | Lifeguard Ambulance Service of Illinois Inc. | Ambulance | 219 W Jackson St, Macomb, IL 61455 | 2018-02-22 |
| 1821516816 | Michelle Deann Sargeant | Speech-Language Pathologist | 315 N. Bonham, Macomb, IL 61455 | 2017-08-30 |
| 1972020360 | Kara Marie Wright | Speech-Language Pathologist | 315 N. Bonham St., Macomb, IL 61455 | 2017-08-25 |
| 1720356504 | Dawn M. Kedzior | Social Worker | 103 South Johnson Street, Macomb, IL 61455 | 2011-12-07 |
| 1255632642 | Michael Kurt Sharp | Audiologist | Memorial Hall, Second Floor, W Murray St, Macomb, IL 61455 | 2010-11-16 |
| 1952538704 | Mary L. Smith | Developmental Therapist | 1 University Circle, Western Il Univ, Cntr for Best Practices In Early Childhood Education, Macomb, IL 61455 | 2009-06-19 |
| 1982857827 | Macomb Oncology Institute Ltd | Radiology | 401 East Grant Street, Macomb, IL 61455 | 2008-10-23 |
| 1245488345 | Sonja E Schmidt | Social Worker | 119 Wetzel Hall, Western Illinois University, Macomb, IL 61455 | 2008-09-03 |
| Find all providers in zip 61455 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730714262 | Kendra Khan | Nurse Practitioner | 47340 Savannah Dr, Macomb, MI 48044-2795 | 2020-03-04 |
| 1225661267 | Michelle Kelli Thomas | Nurse Practitioner | 48221 Farah Dr, Macomb, MI 48044-2010 | 2020-02-18 |
| 1609424506 | Carla E Butcher | Nurse Practitioner | 51538 Silver Bell Dr, Macomb, MI 48042-4348 | 2019-09-04 |
| 1972162337 | Karla Ostaszewski | Nurse Practitioner | 48153 Virginia Dr, Macomb, MI 48044-4906 | 2019-06-10 |
| 1962960518 | Matthew Thomas Maraman | Nurse Practitioner | 23572 Shepherd Ln, Macomb, MI 48042-5517 | 2019-03-03 |
| 1861957383 | John Mrachina | Nurse Practitioner | 19612 Hudson River Dr, Macomb, MI 48044-4242 | 2019-02-08 |
| 1942765680 | Trinia Ann Nappo | Nurse Practitioner | 49195 Deneweth Farms Dr, Macomb, MI 48044-1553 | 2019-02-06 |
| 1558833632 | Carol Hilliker | Nurse Practitioner | 46326 Sawyer Ln, Macomb, MI 48044-6218 | 2018-12-29 |
| 1295249951 | Quinnkeela L Nash-el | Nurse Practitioner | 21360 John Dr, Macomb, MI 48044-6405 | 2017-11-16 |
| 1841724929 | Myla Guangco Bacalso | Nurse Practitioner | 50083 Margaret Ave, Macomb, MI 48044-6340 | 2017-04-17 |
| Find all providers in MACOMB | ||||
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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.