Active NPI
Jennifer M Wallace, NP
- Nurse Practitioner
- Springfield, MA
National Provider Identifier
1235379090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- RN218174
- Practice address
- 3640 Main St
Suite 302
Springfield, MA 01107-1145 - Phone
- (413) 732-4242
- Fax
- (413) 732-4040
- NPI assigned
- Mar 5, 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | RN218174 | MA | Primary |
Addresses
Primary practice location
3640 Main St
Suite 302
Springfield, MA 01107-1145
Mailing address
3640 Main St
Suite 302
Springfield, MA 01107-1145
Phone (413) 732-4242
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)
- Enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1236211200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1461196800000",
"number": "1235379090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3640 MAIN ST",
"address_2": "SUITE 302",
"city": "SPRINGFIELD",
"state": "MA",
"postal_code": "011071145",
"telephone_number": "413-732-4242",
"fax_number": "413-732-4040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3640 MAIN ST",
"address_2": "SUITE 302",
"city": "SPRINGFIELD",
"state": "MA",
"postal_code": "011071145",
"telephone_number": "413-732-4242",
"fax_number": "413-732-4040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "JENNIFER",
"middle_name": "M",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-03-05",
"last_updated": "2016-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MA",
"license": "RN218174",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.