Peggy Ann Wallace, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

031264 Issued in AZ

Practice address

7428 E Baseline Rd
Mesa, AZ 85209-4902

Phone

(480) 334-5385

NPI assigned

Aug 29, 2014

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

State licenses

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

{
    "created_epoch": "1409270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409270400000",
    "number": "1609276344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7428 E BASELINE RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852094902",
            "telephone_number": "480-334-5385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7428 E BASELINE RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852094902",
            "telephone_number": "480-334-5385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "PEGGY",
        "middle_name": "ANN",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-29",
        "last_updated": "2014-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "AZ",
            "license": "031264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Ellis Walker, M.D.
• Brandon Wall
• Matthew Ryan Wall, D.D.S.
• Wallace Chiropractic, PC
• Kristine Wallace, N.D.
• Ryan Scott Wallin, DDS
• Harvey W Wallmann, PT, DSC
• Walmart Inc.
• Walmart Inc.
• Walmart Inc.

• Licensed Practical Nurse in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Licensed Practical Nurse in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2014; 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.