Robin L Wallace, ARNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

60190019 Issued in WA

Practice address

3901 Hoyt Ave
Everett, WA 98201-4918

Phone

(425) 339-5413

Fax

(425) 339-4213

NPI assigned

Oct 15, 2010

Last updated

Oct 15, 2010By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1287100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287100800000",
    "number": "1073823688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 HOYT AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014918",
            "telephone_number": "425-339-5413",
            "fax_number": "425-339-4213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 HOYT AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014918",
            "telephone_number": "425-339-5413",
            "fax_number": "425-339-4213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ROBIN",
        "middle_name": "L",
        "credential": "ARNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-15",
        "last_updated": "2010-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "60190019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AP STATE LICENSE",
            "identifier": "60190019",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gary A Wall Jr., D.D.S.
• Tonya Renee Wall, MSW
• Jennifer Wallace
• Kathryn Ann Wallace, R.N.
• Kent William Wallace, PA-C, ARNP
• Sarah Wallace
• Lorreta Akinyi Wallen
• Jacob Waller, D.C.
• Eric Wallin
• Jonathan Thomas Wallis, MA, LMHCA

• Nurse Practitioner in Everett, WA
• Providers in Everett, WA by specialty
• Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2010; 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.