Latrice Shemon Wallace, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

257195 Issued in WI

Practice address

7009 N 43Rd St # 7a
Milwaukee, WI 53209-2263

Phone

(414) 574-8984

NPI assigned

Jan 16, 2021

Last updated

Jan 16, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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": "1610755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610755200000",
    "number": "1326637042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7009 N 43RD ST # 7A",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532092263",
            "telephone_number": "414-574-8984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7009 N 43RD ST # 7A",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532092263",
            "telephone_number": "414-574-8984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "LATRICE",
        "middle_name": "SHEMON",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-16",
        "last_updated": "2021-01-16",
        "certification_date": "2021-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "257195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carly Rosemary Frances Wallace
• Christian Alexander Wallace, PA-C
• Courtney Wallace, APSW
• Dominique Wallace
• Francheska Wallace
• Lyndsey Wallace, PSYD
• Megan A Wallace, BA
• Michael David Wallace, LCSW
• Prestyne S. Wallace
• Raymond B Wallace, D.O.

• Registered Nurse in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Registered Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2021; 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.