Dionne Lanette Wallace, MSN RN CNL

Primary specialty

Medical-Surgical Registered NurseTaxonomy code 163WM0705X

License

4704260135 Issued in MI

Practice address

15730 Mok Ave
Eastpointe, MI 48021-2367

Phone

(586) 241-7088

Fax

(585) 585-9555

NPI assigned

Sep 15, 2017

Last updated

May 11, 2023By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science - Nursing, Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Care Compassion Center Corp

  • Adult Day Care Clinic/Center
  • Eastpointe, MI
  • NPI 1396531877

  Single Specialty

  NPD Authorized official
• D Wallace Health Promotion and Wellness

  • Nursing Care Agency
  • Eastpointe, MI
  • NPI 1205347812
  NPD Authorized official

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

{
    "created_epoch": "1505433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683763200000",
    "number": "1386163830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15730 MOK AVE",
            "city": "EASTPOINTE",
            "state": "MI",
            "postal_code": "480212367",
            "telephone_number": "586-241-7088",
            "fax_number": "585-585-9555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15730 MOK AVE",
            "city": "EASTPOINTE",
            "state": "MI",
            "postal_code": "480212367",
            "telephone_number": "586-241-7088",
            "fax_number": "585-585-9555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "DIONNE",
        "middle_name": "LANETTE",
        "name_prefix": "Mrs.",
        "credential": "MSN RN CNL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-15",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "MI",
            "license": "4704260135",
            "primary": true
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "MI",
            "license": "4704260135",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• W Fraser Vipond M.D.,P.C.
• Walgreen Co (Walgreens #4795)
• Shawnese Marie Walker Worthem, MASTERS OF SOCIAL WO
• Kristal Walker
• Simone Walker
• Issis Wallace
• Kiesa Waller, OWNER
• Jamilah Walls
• Marianne Walsh
• Danielle Wansley

• Medical-Surgical Registered Nurse in Eastpointe, MI
• Providers in Eastpointe, MI by specialty
• Medical-Surgical Registered Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2023; 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.