Amber Leigh Wallace, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

4703108739 Issued in MI

Practice address

113 Riverside Dr
Hart, MI 49420-1077

Phone

(231) 220-4620

NPI assigned

Mar 31, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Amber Leigh Polk Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1459382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459382400000",
    "number": "1043673643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 RIVERSIDE DR",
            "city": "HART",
            "state": "MI",
            "postal_code": "494201077",
            "telephone_number": "231-220-4620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 RIVERSIDE DR",
            "city": "HART",
            "state": "MI",
            "postal_code": "494201077",
            "telephone_number": "231-220-4620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "AMBER",
        "middle_name": "LEIGH",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-31",
        "last_updated": "2016-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MI",
            "license": "4703108739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMBER",
            "last_name": "POLK",
            "middle_name": "LEIGH",
            "credential": "LPN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Derek Vangalder
• Chloe Sue Veilleux
• Paul A Wagner, DO
• Leeann R Wahr, RDH
• Lawrence Daniel Walker, D.D.S.
• Deborah A Windell, OTRL
• Luke Wisniewski, DDS
• James Young

• Licensed Practical Nurse in Hart, MI
• Providers in Hart, MI by specialty
• Licensed Practical Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2016; 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.