MRS. CYNTHIA WALLACE (NPI# 1811393648) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1811393648 |
Entity Type | Individual |
Full Name | MRS. CYNTHIA WALLACE |
Credential | AGPCNP |
Practice Address |
1111 Crater Lake Ave Medford OR 97504-6241 |
Mailing Address |
Po Box 3308 Portland OR 97208-3308 |
Practice Telephone | 5417325250 |
Practice Fax Number | 5417325251 |
Mailing Telephone | 5417325250 |
Mailing Fax Number | 5417325152 |
Enumeration Date | 2014-11-05 |
Last Update Date | 2020-09-30 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
201500016NP-PP | OR | Physician Assistants & Advanced Practice Nursing Providers |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1427677848 | Cynthia Wallace | Home Health Aide | 4513 Minaret Way, North Las Vegas, NV 89031-4319 | 2020-04-15 |
1215290051 | Cynthia Wallace | Home Health Aide | 3538 Stanton Rd Se, Washington, DC 20020-2288 | 2012-06-18 |
1093075913 | Cynthia Wallace | Social Worker | 19 E Birch St Ste 103, Walla Walla, WA 99362-3084 | 2012-05-24 |
1841509569 | Cynthia Jane Wallace | Registered Nurse | 310 Eastwood Ave, Delaware, OH 43015-1004 | 2010-09-29 |
1740241835 | Cynthia Calbert Wallace | Obstetrics & Gynecology | 2000 Se Blue Pkwy, Lees Summit, MO 64063-1041 | 2006-03-29 |
1386615540 | Cynthia L Wallace | Family Medicine | 4777 Andrew Jackson Pkwy, Suite 101, Hermitage, TN 37076-1356 | 2006-01-27 |
1528573524 | Cynthia Wallace | Counselor | 914 Baumann Dr, Grand Island, NE 68803-4401 | 2017-12-12 |
1619487410 | Cynthia Marie Wallace | Counselor | 5648 Friendship Ave, Pittsburgh, PA 15206-3610 | 2017-10-05 |
1942608088 | Cynthia Wallace | Social Worker | 832 Mckinley Ave Nw, Canton, OH 44703-2463 | 2014-12-05 |
1730596875 | Cynthia Catherine Wallace | Dermatology | 5530 Wisconsin Ave, 820, Chevy Chase, MD 20815-4404 | 2014-07-21 |
Street Address |
1111 CRATER LAKE AVE |
City | MEDFORD |
State | OR |
Zip Code | 97504-6241 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1558361378 | Craig S. Thalacker | Emergency Medicine | 1111 Crater Lake Ave, Medford, OR 97504-6241 | 2005-07-22 |
1447865464 | Annabel M Walker | Nurse Practitioner | 1111 Crater Lake Ave, Medford, OR 97504-6241 | 2020-09-15 |
1386256519 | Ryan Tierney | Physical Therapist | 1111 Crater Lake Ave, Medford, OR 97504-6241 | 2020-08-19 |
1992362867 | Courtney Howarth | Physical Therapy Assistant | 1111 Crater Lake Ave, Medford, OR 97504-6241 | 2019-05-24 |
1811470107 | Nicole Marie Choyce | Dietitian, Registered | 1111 Crater Lake Ave, Medford, OR 97504-6241 | 2018-09-12 |
1336621721 | Tai Bailey Shelton | Physical Therapist | 1111 Crater Lake Ave, Medford, OR 97504-6241 | 2018-08-31 |
1932681533 | Jacqueline Lucas-morris | Occupational Therapist | 1111 Crater Lake Ave, Medford, OR 97504-6241 | 2018-08-30 |
1477035236 | Sarah Rae Hanley | Occupational Therapist | 1111 Crater Lake Ave, Medford, OR 97504-6241 | 2018-08-29 |
1306327242 | Elizabeth Carlton | Physical Therapist | 1111 Crater Lake Ave, Medford, OR 97504-6241 | 2018-08-28 |
1851872428 | Ida Marielke Funke | Physical Therapist | 1111 Crater Lake Ave, Medford, OR 97504-6241 | 2018-08-22 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1225673833 | Lydia D Sneed | Behavioral Analyst | 3707 Citation Way, Suite 102, Medford, OR 97504 | 2019-11-07 |
1114577368 | Heather Ashley Fronek | Nurse Practitioner | 2825 E. Barnett Rd., Medford, OR 97504 | 2019-09-18 |
1255809109 | Justin Blasdel | Technician, Health Information | 3250 Lone Pine Rd, Medford, OR 97504 | 2018-11-08 |
1396220133 | Aimee K Michel | Massage Therapist | 3550 National Dr., Medford, OR 97504 | 2018-09-27 |
1437646908 | Zola Dental Medford LLC | Dentist | 922 E Main, Medford, OR 97504 | 2018-04-19 |
1376068015 | Megan Leggett | Counselor | 777 Murphy Road, Medford, OR 97504 | 2017-08-03 |
1023547536 | Joshua Morgan Rice | Dentist | 1117 E Main St Ste 1, Medford, OR 97504 | 2017-06-08 |
1427580232 | Paul James Dean | Counselor | 1175 Main St Ste 1c, Medford, OR 97504 | 2017-03-30 |
1811443542 | Taya Adams | Doula | 1201 Progress Dr #90, Medford, OR 97504 | 2016-09-01 |
1174076228 | Avalon Health Care - Hearthstone, LLC | Skilled Nursing Facility | 2091 E. Barnett Road, Medford, OR 97504 | 2016-07-25 |
Find all providers in zip 97504 |
Taxonomy Code | 363LG0600X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Gerontology |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1417581315 | Well Spring Health LLC | Nurse Practitioner | 835 Crater Lake Ave, Medford, OR 97504-6505 | 2020-02-28 |
1861926586 | Dashia Hewitt | Nurse Practitioner | 825 Bennett Ave, Medford, OR 97504-6715 | 2017-04-19 |
1396143624 | Laurie Young | Nurse Practitioner | 170 Governors Ave, Medford, MA 02155-1643 | 2014-12-19 |
1427181767 | Landa Rhoda Cox | Nurse Practitioner | 1200 Mira Mar Ave, Medford, OR 97504-8546 | 2007-03-14 |
1376521369 | Stacey Bryant | Nurse Practitioner | 170 Governors Ave, Hallmark Health System, Inc., Medford, MA 02155-1643 | 2006-01-09 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1558383430 | Nancy A Erb | Nurse Practitioner | 16209 W Hoffeldt Ln, Suite B, Brookings, OR 97415-9470 | 2006-07-23 |
1124058789 | Elizabeth Vonwellsheim | Nurse Practitioner | 382b South 58th Street, Springfield, OR 97478 | 2006-07-03 |
1568419091 | Carolyn Dolores Concia | Nurse Practitioner | 2308 Nw Stimpson Ln, Portland, OR 97229-8562 | 2006-05-30 |
1821647173 | Haley Grace Ruljancich | Nurse Practitioner | 4010 Aerial Way, Eugene, OR 97402-9757 | 2019-09-10 |
1043862550 | Katherine Felicia Edstrom | Nurse Practitioner | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2019-07-15 |
1487216669 | Carolyn D Concia Np Prof Corp | Nurse Practitioner | 2308 Nw Stimpson Ln, Portland, OR 97229-8562 | 2019-07-08 |
1811550866 | Elisa Denise Garrett | Nurse Practitioner | 675 N 5th St, Lebanon, OR 97355-2875 | 2019-04-16 |
1255800850 | Peter Woodring | Nurse Practitioner | 610 Hawthorne Ave Se Ste 110, Salem, OR 97301-5378 | 2018-11-13 |
1154809903 | Molly Christine Davis | Nurse Practitioner | 4805 Ne Glisan St Ste 11n, Portland, OR 97213-2933 | 2018-08-03 |
1851841357 | Marquis Companies I, Inc. | Nurse Practitioner | 4560 Se International Way, Suite 100, Milwaukie, OR 97222-4628 | 2016-10-07 |
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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.