D Wallace Health Promotion and Wellness

Primary specialty

Nursing Care AgencyTaxonomy code 251J00000X

License

4704260135 Issued in MI

Legal business name

D WALLACE HEALTH PROMOTION AND WELLNESS

Practice address

15730 Mok Ave
Eastpointe, MI 48021-2367

Phone

(313) 415-1538

Fax

(586) 585-9555

NPI assigned

Oct 23, 2017

Last updated

Oct 23, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Dionne Lanette Wallace, MSN RN CNLNPI 1386163830

Title

Founder/Chief Administator

Phone

(586) 241-7088

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dionne Lanette Wallace, MSN RN CNL

  • Medical-Surgical Registered Nurse
  • Eastpointe, MI
  • NPI 1386163830
  NPD Authorized official
• Christal Eason, LMSW, CAAC

  • Clinical Social Worker
  • Southfield, MI
  • NPI 1790924470
  NPD (past)

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

{
    "created_epoch": "1508716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508716800000",
    "number": "1205347812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15730 MOK AVE",
            "city": "EASTPOINTE",
            "state": "MI",
            "postal_code": "480212367",
            "telephone_number": "313-415-1538",
            "fax_number": "586-585-9555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15730 MOK AVE",
            "city": "EASTPOINTE",
            "state": "MI",
            "postal_code": "480212367",
            "telephone_number": "313-415-1538",
            "fax_number": "586-585-9555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D WALLACE HEALTH PROMOTION AND WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-23",
        "last_updated": "2017-10-23",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "DIONNE",
        "authorized_official_middle_name": "LANETTE",
        "authorized_official_title_or_position": "FOUNDER/CHIEF ADMINISTATOR",
        "authorized_official_telephone_number": "586-241-7088",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSN RN CNL"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "MI",
            "license": "4704260135",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nursing Care Agency in Eastpointe, MI
• Providers in Eastpointe, MI by specialty
• Nursing Care Agency in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2017; 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.