Anabel Rafaela Disla Wallace, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

SP032861 Issued in PA

Practice address

6431 Sackett St
Philadelphia, PA 19149

Phone

(267) 448-4908

Fax

(267) 297-3950

NPI assigned

May 26, 2025

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

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dedicated Pennsylvania Holding LLCGroup PAC ID 4688935653, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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

• Dedicated Pennsylvania Holding, LLC

  • Specialist
  • Philadelphia, PA
  • NPI 1477053569
  Medicare reassignment Care Compare group NPD
• Dedicated Pennsylvania Holding, LLC

  • Specialist
  • Philadelphia, PA
  • NPI 1366950776
  NPD
• Dedicated Pennsylvania Holding, LLC

  • Specialist
  • Philadelphia, PA
  • NPI 1841707965
  NPD

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

{
    "created_epoch": "1748217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753747200000",
    "number": "1487447231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6431 SACKETT ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6431 SACKETT ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19149",
            "telephone_number": "267-448-4908",
            "fax_number": "267-297-3950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISLA WALLACE",
        "first_name": "ANABEL",
        "middle_name": "RAFAELA",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-05-26",
        "last_updated": "2025-07-29",
        "certification_date": "2025-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP032861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Verdi J. Disesa, M.D.
• Reagan Dishaw, RD, LDN
• Mary L Disilva, CRNP
• Christopher J Disilvestro, RPH
• Gregory Michael Disilvio, DO
• Dina Disney, OTR/L
• Mauro Antonio Dispagna, MD
• Livia Serena Dispenza
• Alexis Dispenziere
• Nathaniel Peter Disser, MD

• Family Nurse Practitioner in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Family Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.