MRS. TRACEE MARIE WALLACE


Address: 5255 Loughboro Rd Nw, Washington, DC 20016-2633
Phone: 2025374000

MRS. TRACEE MARIE WALLACE (NPI# 1811128010) 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) 1811128010
Entity Type Individual
Full Name MRS. TRACEE MARIE WALLACE
Other Name MS. TRACEE MARIE HERMANSON
Credential PA-C
Practice Address 5255 Loughboro Rd Nw
Washington
DC 20016-2633
Mailing Address 5805 Edson Ln
Rockville
MD 20852-2925
Practice Telephone 2025374000
Mailing Telephone 5055731388
Enumeration Date 2009-08-05
Last Update Date 2017-03-28
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363AS0400X Physician Assistant
Specialization: Surgical Technologist
PA031280 DC Physician Assistants & Advanced Practice Nursing Providers

Other Providers TRACEE WALLACE

NPI Name Taxonomy Address Enumeration
1679182539 Tracee Wallace Assistant Behavior Analyst 963 Texas St, Mobile, AL 36604-3148 2020-07-27

Office Location

Street Address 5255 LOUGHBORO RD NW
City WASHINGTON
State DC
Zip Code 20016-2633

Providers in the same location

NPI Name Taxonomy Address Enumeration
1013910884 Lawrence D Ramunno Family Medicine 5255 Loughboro Rd Nw, Washington, DC 20016-2633 2005-05-24
1164023701 Elizabeth Louise Echols Registered Nurse 5255 Loughboro Rd Nw, Washington, DC 20016-2633 2020-11-02
1932715364 Ifeyinwa Nwokike Nurse Practitioner 5255 Loughboro Rd Nw, Washington, DC 20016-2633 2020-09-21
1881209286 Shahane Everett Registered Nurse 5255 Loughboro Rd Nw, Washington, DC 20016-2633 2020-09-11
1104431048 Julie Butchart Nurse Practitioner 5255 Loughboro Rd Nw, Washington, DC 20016-2633 2020-09-08
1609493758 Debra Mims Doula 5255 Loughboro Rd Nw, Washington, DC 20016-2633 2020-07-05
1982226254 Ikenna L Unegbu Pharmacist 5255 Loughboro Rd Nw, Washington, DC 20016-2633 2020-05-10
1871122713 Valentina Wigozki Physician Assistant 5255 Loughboro Rd Nw, Washington, DC 20016 2020-04-03
1306470166 Jaylon Garrett Nurse Practitioner 5255 Loughboro Rd Nw, Washington, DC 20016-2633 2020-03-02
1639719404 Natalie Shepherd Nurse Practitioner 5255 Loughboro Rd Nw, Washington, DC 20016-2633 2020-01-09
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1790390144 Julie Marcus Nurse Practitioner 4200 Wisconsin Avenue Nw, 4th Floor, Washington, DC 20016 2020-09-12
1669080289 Rachel Mary Lipman Student in an Organized Health Care Education/Training Program 5185 Macarthur Blvd, Washington, DC 20016 2020-07-20
1285253484 Shawn Anthony Haupt Student in an Organized Health Care Education/Training Program 4200 Wisconsin Ave, 4th Floor, Dept of Pediatrics, Washington, DC 20016 2020-04-09
1457991176 Joseph Stephen Driscoll Specialist/Technologist St. Albans School / Mount St, Alban, 3001 Wisconsin Ave, Washington, DC 20016 2020-01-10
1164063293 Christine Ju Dietitian, Registered 3517 Ordway St Nw, Washington, DC 20016 2019-09-30
1376191072 Carlitta Theresa Harris Registered Nurse 501 School Street Suite, Suite 200, Sw, DC 20016 2019-08-27
1295399384 People's Lactation LLC Registered Nurse 3022 Wisconsin Ave Nw Apt 208, Washington, DC 20016 2019-04-24
1578057428 Itzhak Brook General Practice 4431 Albemarle St. Nw, Washington, DC 20016 2018-06-14
1093211724 Hannah Elise Sterling Student in an Organized Health Care Education/Training Program 4200 Wisconsin Ave Nw 4th Floor, Department of Pediatrics, Washington, DC 20016 2018-04-02
1447755616 Michele Elizabeth Zaragoza Student in an Organized Health Care Education/Training Program 4200 Wisconsin Ave Nw, 4th Floor, Dept of Pediatrics, Washington, DC 20016 2018-03-28
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Taxonomy Information

Taxonomy Code 363AS0400X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Surgical Technologist

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1811391022 Shannon Rasmussen Duescher Physician Assistant 3800 Reservoir Rd Nw # 7phc, Washington, DC 20007-2113 2014-10-17
1356623961 Denise Nanette Blackbourne Physician Assistant 106 Irving St Nw Ste 206, Washington, DC 20010-2993 2011-09-09
1114056421 Kevin Joseph Dubree Physician Assistant 110 Irving St, Nw, Unit 1f, Room 1218, Washington, DC 20010-2927 2007-03-04
1225139686 Kimberly Lynn Seablom Physician Assistant 6209 Nebraska Ave Nw, Washington, DC 20015-1144 2006-09-26
1548232887 David Barry Jennette Physician Assistant 1775 Eye St Nw, Suite 1150, Washington, DC 20006-2402 2006-02-02
1699301853 Monica Vu Physician Assistant 111 Michigan Ave Nw, Washington, DC 20010-2916 2020-03-19
1659843803 Kalley Rae Veit Physician Assistant 3800 Reservoir Rd Nw, 1 Gorman, Washington, DC 20007 2018-12-28
1760961494 Katie Ann Leemaster Physician Assistant 2440 M St Nw Ste 200, Washington, DC 20037-1449 2018-08-13
1851885313 Samantha Brooke Bickar Physician Assistant 900 23rd St Nw, Washington, DC 20037-2342 2018-06-19
1265921605 Meredith Patricia Miles Physician Assistant 3800 Reservoir Rd Nw, Washington, DC 20007-2113 2018-05-01
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Competitor

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City WASHINGTON
Zip Code 20016

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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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