Mary Elizabeth Wallace, DNP, CRNP, A-GNP-C

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

R228560 Issued in MD

Practice address

6178 Oxon Hill Rd
Oxon Hill, MD 20745-3109

Phone

(301) 292-9220

NPI assigned

Dec 13, 2023

Last updated

Dec 13, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Enrolled in MD

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/AICIAA

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bhawna Bahethi, MD LLC

  • Internal Medicine Physician
  • Glen Burnie, MD
  • NPI 1457685380
  Medicare reassignment NPD
• Kinetic Medical Group

  • Family Nurse Practitioner
  • Potomac, MD
  • NPI 1285228585
  Medicare reassignment NPD
• Kinetic Primary Care

  • General Practice Physician
  • Potomac, MD
  • NPI 1528761897

  Adult Health

  Medicare reassignment NPD
• Brightwell Health LLC

  • Internal Medicine Physician
  • Glen Burnie, MD
  • NPI 1215515408
  NPD
• Imed Surgical of Oxon Hill PC

  dba Doctor Keloid Scar and Cosmetic Center of Maryland

  • Surgery Physician
  • Oxon Hill, MD
  • NPI 1043856784
  NPD

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

{
    "created_epoch": "1702425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702425600000",
    "number": "1295503829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6178 OXON HILL RD",
            "city": "OXON HILL",
            "state": "MD",
            "postal_code": "207453109",
            "telephone_number": "301-292-9220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6178 OXON HILL RD",
            "city": "OXON HILL",
            "state": "MD",
            "postal_code": "207453109",
            "telephone_number": "301-292-9220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "credential": "DNP, CRNP, A-GNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-13",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MD",
            "license": "R228560",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vishal Mahendra Vijapurkar
• Vincent J Zugay DDS PA
• Vip Therapy & Wellness Services
• Shirley Wakefield
• Lewahn Wallace
• Stephane Wantou Siantou, PHARMD
• Indya Warr
• Washington Open MRI Inc
• Washington Orthopaedic Center (Orthopaedic Subspecialty Rehabilitation)
• Washington Potency & Urology

• Adult Health Nurse Practitioner in Oxon Hill, MD
• Providers in Oxon Hill, MD by specialty
• Adult Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.