Robin Patricia Wallace, D.O.M., LIC. AC.
Individual provider Active NPI Acupuncturist · Glorieta, NM
NPI 1306948948 · NPPES record last updated Mar 2, 2009
Key facts
- NPI
- 1306948948
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Acupuncturist 171100000X
- License
- KO000048L (PA)
- Practice address
- 146 Glory Lane
Glorieta, NM 87535 - Phone
- (505) 231-6684
- Fax
- (505) 884-4015
- NPI assigned
- Sep 3, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AK000355L | PA | MD | Acupuncturist |
| KO000048L | PA | MD | Acupuncturist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | AK000355L | PA | |
| Acupuncturist | 171100000X | KO000048L | PA | Yes |
Addresses
Primary practice location
146 Glory Lane
Glorieta, NM 87535
Mailing address
PO Box 422
Glorieta, NM 87535
Phone (505) 231-6684
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1824619 | Other | PA | HIGHMARK BS-PREM |
Other providers in Glorieta, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 2, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.