Cinda Lou Wallace, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R0804730 Issued in MN

Practice address

1101 Moulton and Parsons Dr
Saint James, MN 56081-5550

Phone

(507) 375-3261

NPI assigned

Nov 29, 2005

Sex

Female

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mayo Clinic Health System-Southwest Minnesota Region

  • Multi-Specialty Clinic/Center
  • Mankato, MN
  • NPI 1578545422
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 10, 2021.

{
    "created_epoch": "1133222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610236800000",
    "number": "1003899535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 MARSH ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014752",
            "telephone_number": "507-625-4031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 MOULTON AND PARSONS DR",
            "city": "SAINT JAMES",
            "state": "MN",
            "postal_code": "560815550",
            "telephone_number": "507-375-3261"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "115 Drew Ave SE",
            "address_purpose": "LOCATION",
            "city": "Madelia",
            "state": "MN",
            "postal_code": "560621841",
            "country_code": "US",
            "telephone_number": "507-642-3241",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CINDA",
        "middle_name": "LOU",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-29",
        "last_updated": "2021-01-10",
        "certification_date": "2021-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R0804730",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Alan Steele, NP-C
• The Evangelical Lutheran Good Samaritan Society
• The Evangelical Lutheran Good Samaritan Society
• Unity Transportation
• Sean Patrick Vostad, BS, DDS
• Watonwan County
• Wellspring Faith in Action
• Paul R Windschill, RPH
• Dawn Witcraft
• Youngren Family Dental Care Center, Inc.

• All providers in Saint James, MN
• Family Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.