Stephanie Wallace, APRN CNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN.CNP.0030395 Issued in OH

Practice address

4807 Rockside Rd Ste 100
Independence, OH 44131-2188

Phone

(216) 524-4009

NPI assigned

May 16, 2023

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

Medicare fee-for-service enrollment

Enrolled in OH

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 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northcoast Dermatology Associates, Inc.Group PAC ID 0648212167, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Master of Science, Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Northcoast Dermatology Associates, Inc.

  • Dermatology Physician
  • Independence, OH
  • NPI 1750347480
  Medicare reassignment Care Compare group NPD
• Northcoast Dermatology Associates, Inc.

  • Dermatology Physician
  • Independence, OH
  • NPI 1780994517
  NPD

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

{
    "created_epoch": "1684195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763337600000",
    "number": "1194416792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4807 ROCKSIDE RD STE 100",
            "city": "INDEPENDENCE",
            "state": "OH",
            "postal_code": "441312188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4807 ROCKSIDE RD STE 100",
            "city": "INDEPENDENCE",
            "state": "OH",
            "postal_code": "441312188",
            "telephone_number": "216-524-4009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "STEPHANIE",
        "credential": "APRN CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-16",
        "last_updated": "2025-11-17",
        "certification_date": "2025-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.0030395",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miranda Jo Villard, LPCC
• Michelle Wagner-Skinner, PT
• Walgreen Co
• Noel W. Walker, LISW
• Mitchell Wallace
• Christine Yusi Wang, DO
• Caitlin Wantz
• Lisa M Warren, COTAL
• Ilka Warshawsky, MD
• Stacie Watters

• Family Nurse Practitioner in Independence, OH
• Providers in Independence, OH by specialty
• Family Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.