Gina Marie Wallace, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

586664 Issued in NY

Practice address

970 Route 146
Clifton Park, NY 12065-3643

Phone

(518) 881-0461

NPI assigned

Oct 5, 2011

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

Practice roles

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.

• Shenendehowa Central Schools

  • Local Education Agency (LEA)
  • Clifton Park, NY
  • NPI 1366726473
  NPD (past)

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

{
    "created_epoch": "1317772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325635200000",
    "number": "1598049801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "970 ROUTE 146",
            "city": "CLIFTON PARK",
            "state": "NY",
            "postal_code": "120653643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "970 ROUTE 146",
            "city": "CLIFTON PARK",
            "state": "NY",
            "postal_code": "120653643",
            "telephone_number": "518-881-0461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "GINA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-05",
        "last_updated": "2012-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "586664",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blair Vogel
• Carolyn Lee Von Schenk, O.T.
• Jessica Shirley Wagoner, MS/OT
• Wal-Mart Stores East, LP
• Walgreen Co
• Kristine Margaret Wanmer, PT
• John T Ward, R.PH.
• Thomas P Ward
• Rachel Lauren Watson
• David Weaver, OD

• Registered Nurse in Clifton Park, NY
• Providers in Clifton Park, NY by specialty
• Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2012; 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.