Active NPI
Jennifer Anne Waller, RN
- Registered Nurse
- Gallup, NM
National Provider Identifier
1114167889
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN595702
- Practice address
- 516 Nizhoni Blvd
Gallup, NM 87301-5748 - Phone
- (505) 722-1315
- Fax
- (505) 722-1310
- NPI assigned
- Feb 20, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN595702 | PA | Primary |
Addresses
Primary practice location
516 Nizhoni Blvd
Gallup, NM 87301-5748
Mailing address
516 Nizhoni Blvd
Gallup, NM 87301-5748
Phone (505) 722-1315
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN595702 | PA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235088000000",
"number": "1114167889",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "516 NIZHONI BLVD",
"city": "GALLUP",
"state": "NM",
"postal_code": "873015748",
"telephone_number": "505-722-1315",
"fax_number": "505-722-1310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "516 NIZHONI BLVD",
"city": "GALLUP",
"state": "NM",
"postal_code": "873015748",
"telephone_number": "505-722-1315",
"fax_number": "505-722-1310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLER",
"first_name": "JENNIFER",
"middle_name": "ANNE",
"name_prefix": "Ms.",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-02-20",
"last_updated": "2009-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "PA",
"license": "RN595702",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gallup, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.