Kenda Joleen Wallace, RN

Primary specialty

Infection Control Registered NurseTaxonomy code 163WI0600X

License

E42490 Issued in CT

Practice address

4212 North 16TH St,
Phoenix, AZ 85016

Phone

(602) 263-1511

Fax

(602) 263-1619

NPI assigned

Dec 11, 2006

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1316007339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-0698",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911100698",
            "telephone_number": "602-263-1511",
            "fax_number": "602-263-1619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4212 NORTH 16TH ST,",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85016",
            "telephone_number": "602-263-1511",
            "fax_number": "602-263-1619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KENDA",
        "middle_name": "JOLEEN",
        "name_prefix": "Ms.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WI0600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Infection Control",
            "state": "CT",
            "license": "E42490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donna C Wallace, PNP
• Evelyn J Wallace, RN
• Hattie Wallace
• John Wallace, M.D.
• Justin Covey Wallace, RN
• Maegen J Wallace, M.D.
• Mary Michelle Wallace, N.P.
• Robert C Wallace, M.D.
• Suemoy S Wallace, M.D.
• Sydney L Wallace, LAC

• Infection Control Registered Nurse in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Infection Control Registered Nurse in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.