Amanda Kaitlin Wallace, RN

Key facts

NPI

1093632176

Entity type

Individual (NPI type 1)

Primary specialty

Lactation Consultant (Registered Nurse) 163WL0100X

License

201500633RN (OR)

Practice address

1663 NW Edgar St
McMinnville, OR 97128-3044

Phone

(971) 746-9158

NPI assigned

Jun 30, 2026

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 30, 2026.

{
    "created_epoch": "1782777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782777600000",
    "number": "1093632176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1663 NW EDGAR ST",
            "city": "MCMINNVILLE",
            "state": "OR",
            "postal_code": "971283044",
            "telephone_number": "971-746-9158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1663 NW EDGAR ST",
            "city": "MCMINNVILLE",
            "state": "OR",
            "postal_code": "971283044",
            "telephone_number": "971-746-9158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "AMANDA",
        "middle_name": "KAITLIN",
        "name_prefix": "Miss",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-06-30",
        "last_updated": "2026-06-30",
        "certification_date": "2026-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "OR",
            "license": "201500633RN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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