GABRIEL WAYNE WALLACE (NPI# 1932571056) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932571056 |
| Entity Type | Individual |
| Full Name | GABRIEL WAYNE WALLACE |
| Practice Address |
5208 Michiban Ave. Prescott MI 48756 |
| Mailing Address |
Po Box 4424 Prescott MI 48756-4424 |
| Practice Telephone | 9893059629 |
| Practice Fax Number | 9898731225 |
| Mailing Telephone | 9893059629 |
| Mailing Fax Number | 9898731225 |
| Enumeration Date | 2015-10-28 |
| Last Update Date | 2015-10-28 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3747P1801X |
Technician Specialization: Personal Care Attendant |
7666037 | MI | Nursing Service Related Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 7666037 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609142074 | Gabriel Abraham Wallace | Surgery | 10258 Southwest Hwy Ste A, Chicago Ridge, IL 60415-1361 | 2012-03-29 |
| Street Address |
5208 MICHIBAN AVE. |
| City | PRESCOTT |
| State | MI |
| Zip Code | 48756 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881622835 | Prescott Clinic P.C. | Family Medicine | 125 Washington, Prescott, MI 48756 | 2006-06-29 |
| 1568005569 | Jennifer Lynn Datzko | Nurse Practitioner | 125 N Washington St, Prescott, MI 48756-5117 | 2019-10-22 |
| 1295248508 | Prescott Clinic P.C. | Family Medicine | 125 N Washington St, Prescott, MI 48756-5117 | 2017-11-08 |
| 1407194954 | Jimmie S Ward Sr. | Physician Assistant | 125 Washington Ave, Prescott, MI 48756-5117 | 2013-01-17 |
| 1992831960 | Charles E Jessup | Family Medicine | 125 N Washington St, Prescott, MI 48756-5117 | 2007-02-26 |
| 1578626735 | Richard Steven Gaft | Emergency Medicine | 125 N Washington St, Box 114, Prescott, MI 48756-5117 | 2006-12-19 |
| 1659379915 | Antonio F Mendiola Jr. | General Practice | 1827 Greenwood Rd, Prescott, MI 48756-8626 | 2005-07-12 |
| 1881679645 | Sterling Area Health Center | Clinic/Center | 1827 Greenwood Rd, Prescott, MI 48756-8626 | 2005-12-14 |
| 1851905707 | Skidway Pharmacy LLC | Pharmacy | 1830 Greenwood Rd, Prescott, MI 48756-8627 | 2020-09-08 |
| 1750319083 | Daniel Edward Greene | Chiropractor | 1818 Greenwood Rd, Prescott, MI 48756-8627 | 2006-06-28 |
| Find all providers in zip 48756 | ||||
| Taxonomy Code | 3747P1801X |
| Grouping | Nursing Service Related Providers |
| Classification | Technician |
| Specialization | Personal Care Attendant |
| An individual who provides assistance with eating, bathing, dressing, personal hygiene, activities of daily living as specified in the plan of care. Services which are incidental to the care furnished, or essential to the health and welfare of the individual may also be provided. Personal care providers must meet state defined training and certification standards |
| Notes: [7/1/2003: definition added] |
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|---|---|---|---|---|
| 1164911699 | Susan Stone | Technician | 762 Martin St, Prescott, AR 71857-2749 | 2018-05-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164021028 | Jaharie Green | Technician | 235 Arbor Glen Dr, East Lansing, MI 48823-8459 | 2020-10-21 |
| 1265030555 | Lauren Alexa Remijan | Technician | 18250 Queensbury Dr, Livonia, MI 48152-3946 | 2020-10-09 |
| 1346857067 | Nicholas Luke Roman | Technician | 10452 Lodge Dr, Allendale, MI 49401-9395 | 2020-09-27 |
| 1346856242 | Marissa Jean Brandly | Technician | 768 W Castlebury Cir, Saline, MI 48176-1348 | 2020-09-17 |
| 1962016030 | Stephanie Pertchi | Technician | 10745 48th Ave Unit Q3, Allendale, MI 49401-8127 | 2020-09-04 |
| 1356954705 | Mckenna Shank | Technician | 1409 E Beltline Ave Se, Grand Rapids, MI 49506 | 2020-08-26 |
| 1477166924 | Whispering Pines 2 | Technician | 1878 Soules Rd, Afton, MI 49705-9717 | 2020-08-25 |
| 1659983062 | Serena Selwyn | Technician | 2024 Edgewood Ave Se, Grand Rapids, MI 49546-5718 | 2020-08-18 |
| 1780293043 | Alyn Kristin Kay | Technician | Hope Network-hope's Door Cru, 3699 Miles Rd., Jackson, MI 49201 | 2020-07-23 |
| 1285242420 | Anna Therese Pignone | Technician | 918 E Grand River Ave Apt 718, East Lansing, MI 48823-4597 | 2020-07-14 |
| 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.