Annabel Wallace, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP61177911 Issued in WA

Practice address

200 15TH Ave E
Seattle, WA 98112-5260

Phone

(206) 326-3530

NPI assigned

Mar 26, 2019

Reactivated

Oct 18, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MD, WA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Bellingham Arthritis & Rheumatology

  • Rheumatology Physician
  • Bellingham, WA
  • NPI 1194086579
  Medicare reassignment NPD
• Rheumatology Associates of Baltimore LLC

  • Rheumatology Physician
  • Baltimore, MD
  • NPI 1801829932
  Medicare reassignment NPD

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

{
    "created_epoch": "1553558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634515200000",
    "number": "1063973840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "328 N 74TH ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981035026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 15TH AVE E",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981125260",
            "telephone_number": "206-326-3530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ANNABEL",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-26",
        "last_updated": "2021-10-18",
        "certification_date": "2021-10-18",
        "deactivation_date": "2021-10-01",
        "reactivation_date": "2021-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "WA",
            "license": "RN60670295",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP61177911",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valerie Jane Wall, PH.D.
• Vanessa Wall
• Virginia R Wall, RN, MN, IBCLC
• Wallace R Hodges MD LLC
• Kimberly Wallace Stewart, LMHC
• Betsy Katrina Wallace, LMP
• Carol A Wallace
• Catherine Maria Caska Wallace, PH.D.
• Charles E Wallace, DDS
• Chris C Wallace, LMP

• Family Nurse Practitioner in Seattle, WA
• Providers in Seattle, WA by specialty
• Family Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.