Individual provider Active NPI

Anna Wallace, APRN

  • Nurse Practitioner
  • Newark, DE
National Provider Identifier
1194483792
Registry record updated Dec 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
LP-0010494 Issued in DE
Practice address
4755 Ogletown Stanton Rd
Newark, DE 19718-2200
Phone
(302) 733-1000
NPI assigned
Dec 1, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X LP-0010494 DE Primary

Addresses

Primary practice location

4755 Ogletown Stanton Rd
Newark, DE 19718-2200

Mailing address

1303 Clifford Rd
Wilmington, DE 19805-1313
Phone (302) 893-0762

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
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

Enrollment IDStateProvider typePAC IDDetails
I20220228001499 DE Practitioner - Nurse Practitioner 7618361148 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christiana Care Health Services IncGroup PAC ID 9739097569, 1,480 clinicians

Practice addresses (Care Compare)

4755 Ogletown Stanton Rd
Newark, DE 19718-2200
Phone (302) 733-1663

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Christiana Care Health Services Inc CurrentSince Feb 23, 2022 Accepting new patients
Christiana Care Health Services, Inc CurrentSince Feb 23, 2022 Accepting new patients
Christiana Care Health Services, Inc Nurse Practitioner Current Accepting new patients

Locations

4755 Ogletown Stanton Rd
Ste 1070
Newark, DE 19718
Phone (302) 733-1663

4755 Ogletown Stanton Rd
Newark, DE 19718
Phone (302) 733-1700

3521 Silverside Rd
Ste 1C
Wilmington, DE 19810
Phone (302) 368-3007

1401 Foulk Rd
Ste 100B
Wilmington, DE 19803
Phone (302) 320-9440

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/5c7467fb-60f9-4172-add4-57667a5dfcfa/

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1638316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1194483792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1303 CLIFFORD RD",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198051313",
            "telephone_number": "302-893-0762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4755 OGLETOWN STANTON RD",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197182200",
            "telephone_number": "302-733-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ANNA",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-01",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "DE",
            "license": "LP-0010494",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, DE

Sources for this page

Verify at the official NPI Registry.