Active NPI
Hayley Wallace
- Athletic Trainer
- Oshkosh, WI
National Provider Identifier
1003097825
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 889
- Practice address
- 2725 Jackson St
Oshkosh, WI 54901-1513 - Phone
- (920) 223-7743
- NPI assigned
- Nov 20, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 889 | WI | Primary |
Addresses
Primary practice location
2725 Jackson St
Oshkosh, WI 54901-1513
Mailing address
2725 Jackson St
Oshkosh, WI 54901-1513
Phone (920) 223-7743
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 889 | WI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1195516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1195516800000",
"number": "1003097825",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2725 JACKSON ST",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549011513",
"telephone_number": "920-223-7743"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2725 JACKSON ST",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549011513",
"telephone_number": "920-223-7743"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "HAYLEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-11-20",
"last_updated": "2007-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "889",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oshkosh, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.