Dominique Wallace

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

License

W4201789495600 Issued in WI

Practice address

3739 N 38TH St
Milwaukee, WI 53216-3011

Phone

(262) 672-3139

Fax

(262) 672-3139

NPI assigned

Jul 18, 2025

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1752796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752796800000",
    "number": "1265324511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3739 N 38TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532163011",
            "telephone_number": "262-672-3139",
            "fax_number": "262-672-3139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3739 N 38TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532163011",
            "telephone_number": "262-672-3139",
            "fax_number": "262-672-3139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "DOMINIQUE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-07-18",
        "last_updated": "2025-07-18",
        "certification_date": "2025-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "WI",
            "license": "W4201789495600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meghan Anna Wall, PH.D.
• Brian Ken Wallace, MD
• Carly Rosemary Frances Wallace
• Christian Alexander Wallace, PA-C
• Courtney Wallace, APSW
• Francheska Wallace
• Latrice Shemon Wallace, RN
• Lyndsey Wallace, PSYD
• Megan A Wallace, BA
• Michael David Wallace, LCSW

• Non-emergency Medical Transport (VAN) in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Non-emergency Medical Transport (VAN) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2025; 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.