Active NPI
Debra Wallace
- Registered Nurse
- Dorchester, MA
National Provider Identifier
1285877464
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 236284
- Practice address
- 50 Redfield St
Suite 302
Dorchester, MA 02122-3630 - Phone
- (617) 506-5160
- NPI assigned
- Apr 17, 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 236284 | MA | Primary |
Addresses
Primary practice location
50 Redfield St
Suite 302
Dorchester, MA 02122-3630
Mailing address
50 Redfield St
Suite 302
Dorchester, MA 02122-3630
Phone (617) 506-5160
Other names 1
- Debra Wallace
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 236284 | MA | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Harbor Health Services Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community Health Clinic/Center
- Dorchester, MA
- NPI 1659330496
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1239926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239926400000",
"number": "1285877464",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 REDFIELD ST",
"address_2": "SUITE 302",
"city": "DORCHESTER",
"state": "MA",
"postal_code": "021223630",
"telephone_number": "617-506-5160"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 REDFIELD ST",
"address_2": "SUITE 302",
"city": "DORCHESTER",
"state": "MA",
"postal_code": "021223630",
"telephone_number": "617-506-5160"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "DEBRA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-04-17",
"last_updated": "2009-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MA",
"license": "236284",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "DEBRA",
"last_name": "WALLACE",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Dorchester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.