MARY MEAGHAN WALLACE


Address: 9301 Evening Primrose Path, Austin, TX 78750-3631
Phone: 5128094121

MARY MEAGHAN WALLACE (NPI# 1760986558) 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) 1760986558
Entity Type Individual
Full Name MARY MEAGHAN WALLACE
Practice Address 9301 Evening Primrose Path
Austin
TX 78750-3631
Mailing Address 6624 Fannin St Ste 2380
Houston
TX 77030-2308
Practice Telephone 5128094121
Mailing Telephone 7138006212
Mailing Fax Number 7138006241
Enumeration Date 2018-03-19
Last Update Date 2018-03-19
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 163W00000X Registered Nurse 822658 TX Nursing Service Providers
Y 363LF0000X Nurse Practitioner
Specialization: Family
AP134629 TX Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 9301 EVENING PRIMROSE PATH
City AUSTIN
State TX
Zip Code 78750-3631

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Taxonomy Information

Taxonomy Code 363LF0000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Family

Taxonomy Definition

Definition to come...

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Competitor

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City AUSTIN
Zip Code 78750

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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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