Cynthia Moreno Wallace, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

188951 Issued in NC

Practice address

3000 New Bern Ave
Raleigh, NC 27610-1231

Phone

(919) 350-8779

Fax

(919) 350-8812

NPI assigned

Dec 3, 2009

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

Other names 1

• Cynthia Michelle Moreno Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Interoperability endpoints

• Direct secure messaging: cynthia.wallace.p1@direct.carolinarehab.nextgenshare.com

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

{
    "created_epoch": "1259798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549411200000",
    "number": "1366770307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3809 COMPUTER DR STE 100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276096518",
            "telephone_number": "919-781-9078",
            "fax_number": "919-719-0147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 NEW BERN AVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101231",
            "telephone_number": "919-350-8779",
            "fax_number": "919-350-8812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CYNTHIA",
        "middle_name": "MORENO",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-03",
        "last_updated": "2019-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "188951",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CYNTHIA",
            "last_name": "MORENO",
            "middle_name": "MICHELLE",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ashley Wallace
• Ashley Ayscue Wallace
• Barry Ray Wallace Jr.
• Beverly Rose Wallace
• Courtney Brooke Wallace, PT
• Jocelyn Jones Wallace, LCAS-A, LPC-A
• Julie Anne Wallace, LCMHCA
• Kaitlyn D Wallace, PT
• Kathryn Paige Wallace, CCC-SLP
• Nicole Janeen Wallace, LCMHC

• All providers in Raleigh, NC
• Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2019; 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.