Active NPI
Sarita Wallace
- Registered Nurse
- Reynoldsburg, OH
National Provider Identifier
1043629124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN419057
- Practice address
- 462 Doverwood Dr
Reynoldsburg, OH 43068-1167 - Phone
- (614) 309-2195
- NPI assigned
- Aug 4, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | |||
| Registered Nurse | 163W00000X | RN419057 | OH | Primary |
Addresses
Primary practice location
462 Doverwood Dr
Reynoldsburg, OH 43068-1167
Mailing address
462 Doverwood Dr
Reynoldsburg, OH 43068-1167
Phone (614) 309-2195
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 |
|---|---|---|---|
| RN419057 | OH | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1448582400000",
"number": "1043629124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "462 DOVERWOOD DR",
"city": "REYNOLDSBURG",
"state": "OH",
"postal_code": "430681167",
"telephone_number": "614-309-2195"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "462 DOVERWOOD DR",
"city": "REYNOLDSBURG",
"state": "OH",
"postal_code": "430681167",
"telephone_number": "614-309-2195"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "SARITA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-08-04",
"last_updated": "2015-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": null,
"license": null,
"primary": false
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "OH",
"license": "RN419057",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Reynoldsburg, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.