Rebecca Wallace, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

216162-4405 Issued in UT

Practice address

3838 S 700 E
Suite 200
Salt Lake City, UT 84106-1466

Phone

(801) 261-4988

Fax

(801) 269-9427

NPI assigned

Sep 6, 2005

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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Lifetree Medical Inc

  • Pain Medicine Physician
  • Salt Lake City, UT
  • NPI 1447250147
  NPD (past)
• Omega Interventional Pain PLLC

  • Pain Medicine Physician
  • Salt Lake City, UT
  • NPI 1417253907
  NPD (past)

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

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1227484800000",
    "number": "1104810134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1837 HOLLYWOOD AVE",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841083103",
            "telephone_number": "801-487-4160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3838 S 700 E",
            "address_2": "SUITE 200",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841061466",
            "telephone_number": "801-261-4988",
            "fax_number": "801-269-9427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "REBECCA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-06",
        "last_updated": "2008-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "216162-4405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D1948",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Mark Wallace, R.PH.
• Justice Kassidy Wallace
• Laney Wallace
• Mark Spangler Wallace, DDS
• Marshall W. Wallace, MD
• Robert Duncan Wallace, M.D.
• Sara Elizabeth Wallace, DPT
• Rachel Jo Wallenda
• Brynn Wallentine
• Brenda Lee Waller

• Family Nurse Practitioner in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Family Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2008; 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.