Active NPI
Lisa Carol Wallace, FNP-BC
- Family Nurse Practitioner
- Allerton, IA
National Provider Identifier
1003423658
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- A160503
- Practice address
- 2418 180TH St
Allerton, IA 50008-8715 - Phone
- (641) 203-0726
- NPI assigned
- Sep 28, 2020
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | A160503 | IA | Primary |
Addresses
Primary practice location
2418 180TH St
Allerton, IA 50008-8715
Mailing address
2418 180TH St
Allerton, IA 50008-8715
Phone (641) 203-0726
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | lisa2@sting.graceland.edu | Direct |
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 |
|---|---|---|---|
| A160503 | IA | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1601251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601251200000",
"number": "1003423658",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2418 180TH ST",
"city": "ALLERTON",
"state": "IA",
"postal_code": "500088715",
"telephone_number": "641-203-0726"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2418 180TH ST",
"city": "ALLERTON",
"state": "IA",
"postal_code": "500088715",
"telephone_number": "641-203-0726"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "LISA",
"middle_name": "CAROL",
"name_prefix": "Mrs.",
"credential": "FNP-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-09-28",
"last_updated": "2020-09-28",
"certification_date": "2020-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "IA",
"license": "A160503",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "lisa2@sting.graceland.edu",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "2418 180th St",
"city": "Allerton",
"state": "IA",
"country_code": "US",
"postal_code": "500088715",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Allerton, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.