JOANNE M WALLIS (NPI# 1932370756) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932370756 |
| Entity Type | Individual |
| Full Name | JOANNE M WALLIS |
| Other Name | JODI M WALLIS |
| Credential | PNP |
| Practice Address |
19005 Se 34th St Vancouver WA 98683-1450 |
| Mailing Address |
426 Sw Stark St Fl 9 Portland OR 97204-2347 |
| Practice Telephone | 3607266724 |
| Practice Fax Number | 3607266718 |
| Mailing Telephone | 5039885958 |
| Mailing Fax Number | 5039884093 |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
091000332N2-PNP- | OR | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
AP30006123 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 22959 | 05 | |
| OR | 022959 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 12710 Se Division St, Portland, OR 972363134 | 5039883601 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265437172 | Joanne Wallis | Nurse Practitioner | 1270 Kot-num Road, Warm Springs, OR 97761-1209 | 2005-06-16 |
| Street Address |
19005 SE 34TH ST |
| City | VANCOUVER |
| State | WA |
| Zip Code | 98683-1450 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841842093 | Tasia Davis | Dental Hygienist | 19005 Se 34th St, Vancouver, WA 98683-1450 | 2019-07-09 |
| 1598235954 | Kristen Lee Funk-tracy | Counselor | 19005 Se 34th St, Vancouver, WA 98683-1450 | 2018-11-28 |
| 1760995179 | Sea-mar Community Health Center | Clinic/Center | 19005 Se 34th St, Vancouver, WA 98683-1450 | 2017-11-07 |
| 1083153233 | Sea-mar Community Health Center | Pharmacy | 19005 Se 34th St, Vancouver, WA 98683-1450 | 2017-02-21 |
| 1801335617 | Sea-mar Community Health Center | Clinic/Center | 19005 Se 34th St, Vancouver, WA 98683-1450 | 2017-02-14 |
| 1629517438 | Sea-mar Community Health Center | Clinic/Center | 19005 Se 34th St, Vancouver, WA 98683-1450 | 2017-02-14 |
| 1770025363 | Sea Mar Community Health Centers | Clinic/Center | 19005 Se 34th St, Vancouver, WA 98683-1450 | 2016-11-14 |
| 1255883260 | Sea Mar Community Health Centers | Clinic/Center | 19005 Se 34th St, Building 3, Vancouver, WA 98683-1450 | 2016-10-26 |
| 1770934929 | Sea Mar Community Health Centers | Clinic/Center | 19005 Se 34th St, Building 3, Vancouver, WA 98683-1450 | 2016-06-29 |
| 1497106645 | Sea Mar Community Health Centers | Clinic/Center | 19005 Se 34th St, Building 3, Vancouver, WA 98683-1450 | 2016-06-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235761222 | Nathaniel James Eugene Powell | Behavior Technician | 4101se 192nd Ave, Ste 101, Vancouver, WA 98683 | 2020-02-07 |
| 1295294973 | Ubmhc1, LLC | Clinical Medical Laboratory | 18110 Southeast 34th St, Building 2, Suite 240, Vancouver, WA 98683 | 2019-03-13 |
| 1982116695 | Amy K Adams | Massage Therapist | 2716 Se 169th Ave, X-232, Vancouver, WA 98683 | 2017-11-03 |
| 1477088920 | Alexandra Ransonet | Dental Hygienist | 19111 Se 34th. St., Vancouver, WA 98683 | 2017-04-21 |
| 1639618630 | Digestive Gi Care | Internal Medicine | 305 Sw Chkalov Dr, 111-140, Vancouver, WA 98683 | 2017-02-23 |
| 1447706742 | Jennifer Horst | Massage Therapist | 3401 Se 192nd. Ave. Suite 107, Vancouver, WA 98683 | 2016-08-28 |
| 1154702728 | Kacie Marie Hamreus | Physician Assistant | 3101 Se 192nd Avenue, Vancouver, WA 98683 | 2015-06-09 |
| 1851782338 | Kathryn Wiedeman | Physical Therapy Assistant | 801 Se Park Crestt Ave, Vancouver, WA 98683 | 2015-02-05 |
| 1407255326 | Jesse Ryan Moses | Dentist | 16600 Se 15th Street, Suite A, Vancouver, WA 98683 | 2014-08-15 |
| 1366869893 | Stephen J Wold II | Podiatrist | 16701 Ne Mcgillivray Blvd, Ste 220, Vancouver, WA 98683 | 2014-03-21 |
| Find all providers in zip 98683 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710401450 | Arielle Shoshanna Gordon | Nurse Practitioner | 501 Se 172nd Ave, Vancouver, WA 98684-9542 | 2017-08-02 |
| 1740674530 | Nicole Lara | Nurse Practitioner | 650 N Devine Rd, Suite B, Vancouver, WA 98661-6979 | 2015-03-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841802675 | Michelle Ann Rorie | Nurse Practitioner | 1100 Villanova St Ne, Olympia, WA 98516-5454 | 2020-08-22 |
| 1174132294 | Heather Catherine Pounds | Nurse Practitioner | 4222 Robin Rd W, University Place, WA 98466-1536 | 2020-07-24 |
| 1801410675 | Mi Thi Trieu Tran | Nurse Practitioner | 24611 116th Ave Se, Kent, WA 98030-4939 | 2020-06-08 |
| 1609409085 | Kris Dee Chatman | Nurse Practitioner | 1628 S Mildred St Ste 105, Tacoma, WA 98465-1628 | 2020-02-13 |
| 1912547365 | Thomas Lee Etherton | Nurse Practitioner | 4425 Cole Ct Se, Olympia, WA 98501-4474 | 2020-01-14 |
| 1306489760 | Nikolaus V Voswinkel | Nurse Practitioner | 1420 Terry Ave Unit 202, Seattle, WA 98101-1981 | 2019-10-17 |
| 1518509520 | Sasha Rose Jensen | Nurse Practitioner | 460 West G Street, Forks, WA 98331 | 2019-10-10 |
| 1306487772 | Harmony Kroll | Nurse Practitioner | 23475 225th Way Se, Ste 201, Maple Valley, WA 98038-5294 | 2019-10-07 |
| 1932751658 | Lesly Marie Dosono Barcena | Nurse Practitioner | 6700 Roosevelt Way Ne Apt A211, Seattle, WA 98115-6642 | 2019-07-12 |
| 1912568205 | Andrea Lyn Fellman | Nurse Practitioner | Ideal Option Clinic 328 South Stillaguamish Ave, Arlington, WA 98223-1660 | 2019-06-26 |
| Find all providers with the same taxonomy | ||||
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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.