Active NPI
Marilyn G Wallace, LPN
- Otolaryngology Physician
- Goldsboro, NC
National Provider Identifier
1306256201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 33514
- Practice address
- 2707 Medical Office PL
Goldsboro, NC 27534-9458 - Phone
- (919) 735-9146
- Fax
- (919) 735-0582
- NPI assigned
- Apr 30, 2014
- 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 |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 33514 | NC | Primary |
Addresses
Primary practice location
2707 Medical Office PL
Goldsboro, NC 27534-9458
Mailing address
2707 Medical Office PL
Goldsboro, NC 27534-9458
Phone (919) 735-9146
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1398816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398816000000",
"number": "1306256201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2707 MEDICAL OFFICE PL",
"city": "GOLDSBORO",
"state": "NC",
"postal_code": "275349458",
"telephone_number": "919-735-9146",
"fax_number": "919-735-0582"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2707 MEDICAL OFFICE PL",
"city": "GOLDSBORO",
"state": "NC",
"postal_code": "275349458",
"telephone_number": "919-735-9146",
"fax_number": "919-735-0582"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "MARILYN",
"middle_name": "G",
"name_prefix": "Mrs.",
"credential": "LPN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-04-30",
"last_updated": "2014-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "NC",
"license": "33514",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Goldsboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.