BRANDI WALLACE (NPI# 1982739900) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982739900 |
| Entity Type | Individual |
| Full Name | BRANDI WALLACE |
| Credential | FNP |
| Practice Address |
4622 40th Avenue South Suite A Fargo ND 58104-4394 |
| Mailing Address |
4500 36th Ave S Ste 100 Fargo ND 58104-5275 |
| Practice Telephone | 7013642909 |
| Mailing Telephone | 7013612286 |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2019-10-25 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 149297-030 | WI | Nursing Service Providers |
| N | 163W00000X | Registered Nurse | R144003-8 | MN | Nursing Service Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
R30131 | ND | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2800 Cleveland Ave N, Roseville, MN 551131126 | 6516421825 | |
| 4141 31st Ave S Ste 102, Fargo, ND 58104 | 7013560097 | 7013560061 |
| 4500 36th Ave S Ste 100, Fargo, ND 581045275 | 7013612286 | |
| 4794 50th Ave S, Fargo, ND 581046027 | 7013612286 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356891188 | Brandi Wallace | Nurse's Aide | 2701 17th St, Rock Island, IL 61201-5351 | 2016-10-05 |
| Street Address |
4622 40TH AVENUE SOUTH SUITE A |
| City | FARGO |
| State | ND |
| Zip Code | 58104-4394 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043837347 | Pinnacle Therapy & Wellness, Pllc | Physical Therapist | 4500 36th Ave S Suite 100, Fargo, ND 58104 | 2020-07-02 |
| 1619509858 | Patricia Helen Bathie | Counselor | 4243 Auburn Ave., Fargo, ND 58104 | 2020-02-05 |
| 1346892866 | Elizabeth Olis | Registered Nurse | 2633 55th St. S, Apartment 202, Fargo, ND 58104 | 2019-07-15 |
| 1780247023 | Keith Kirimi Ndege | Physical Therapy Assistant | 5225 23rd Ave South, Fargo, ND 58104 | 2019-04-22 |
| 1346728557 | Ms4 Pllc | Pharmacy | 4476 31st Avenue South, Suite #105, Fargo, ND 58104 | 2018-07-31 |
| 1891286977 | Jessica Rae Majidian | Dentist | 3030 49th St S, Fargo, ND 58104 | 2018-05-23 |
| 1821588500 | Alissa Nichole Larson | Pharmacist | 5675 26th Ave S St. 136a, Fargo, ND 58104 | 2018-05-17 |
| 1790297430 | Northern Lights Dental | Dentist | 4150 19th Ave S, Suite 301, Fargo, ND 58104 | 2017-11-03 |
| 1619406733 | Cobalt Rehabilitation Hospital Fargo LLC | Rehabilitation Hospital | 4671 38th Street S, Fargo, ND 58104 | 2017-06-12 |
| 1790210318 | Homefield Health, LLC | Clinic/Center | 4141 31st Ave S., Ste 102, Fargo, ND 58104 | 2017-04-21 |
| Find all providers in zip 58104 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447872163 | Gina Marie Kinzler | Nurse Practitioner | 4840 23rd Ave S, Fargo, ND 58104-9136 | 2020-05-15 |
| 1669017265 | Haley Faye Wahl | Nurse Practitioner | 761 48th St S, Fargo, ND 58103-7216 | 2019-11-07 |
| 1952882748 | Tonya L Hager | Nurse Practitioner | 1401 32nd St Sw, Fargo, ND 58103-3428 | 2018-08-28 |
| 1295257400 | Nicole L. Mears | Nurse Practitioner | 301 Northern Pacific Ave N, Fargo, ND 58102-4835 | 2017-07-10 |
| 1023491909 | James Troy Upton | Nurse Practitioner | 3000 32nd Avenue, Essentia Health 32nd Avenue Clinic, Fargo, ND 58103-6132 | 2015-07-09 |
| 1437404795 | Melissa Ann Knecht-savey | Nurse Practitioner | 222 Broaway N, Ste. B100e, Fargo, ND 58102-4479 | 2012-07-23 |
| 1457615155 | Chantee Seung Gruenhagen | Nurse Practitioner | 737 North Broadway, Sanford Urology Clinic, Fargo, ND 58122 | 2012-06-27 |
| 1144592486 | Sara B Hansen | Nurse Practitioner | 3955 56th St S Ste D, Fargo, ND 58104-4845 | 2012-02-02 |
| 1740417302 | Beverly Jeanne Greenwald | Nurse Practitioner | 117 22 St S, Fargo, ND 58103 | 2009-06-22 |
| 1104065499 | Tamra A Garberg | Nurse Practitioner | 5257 27th St S Ste 201, Fargo, ND 58104-7782 | 2009-02-11 |
| Find all providers in FARGO | ||||
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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.