Marlene M.B. Wallace, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

209012095 Issued in IL

Practice address

5955 Zeamer Ave
673Rd Medical Group/SGHQ Dod-VA Joint Venture Hospital
Jber, AK 99506-3702

Phone

(907) 580-1035

Fax

(907) 580-3203

NPI assigned

Mar 20, 2006

Sex

Female

Sole proprietor

No

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

Enrolled in IL

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• North American Partners in Anesthesia (Illinois), LLC

  • Anesthesiology Physician
  • Oak Park, IL
  • NPI 1699032524
  Medicare reassignment NPD

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

{
    "created_epoch": "1142812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676246400000",
    "number": "1629037676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5955 ZEAMER AVE",
            "address_2": "673RD MEDICAL GROUP/SGHQ DOD-VA JOINT VENTURE HOSPITAL",
            "city": "JBER",
            "state": "AK",
            "postal_code": "995063702",
            "telephone_number": "907-580-1035",
            "fax_number": "907-580-3203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5955 ZEAMER AVE",
            "address_2": "673RD MEDICAL GROUP/SGHQ DOD-VA JOINT VENTURE HOSPITAL",
            "city": "JBER",
            "state": "AK",
            "postal_code": "995063702",
            "telephone_number": "907-580-1035",
            "fax_number": "907-580-3203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MARLENE",
        "middle_name": "M.B.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-20",
        "last_updated": "2023-02-13",
        "certification_date": "2023-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pain Management",
            "state": "IL",
            "license": "041305554",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209012095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Marc Veronneau, D.O.
• Joanne M Villaflor, RD
• Jeffrey Allen Villalpando
• Dennis Dean Walker, DO
• Justine Walker
• Lorraine Lin Walters, APRN (CNS)
• April C Walton, MD
• Logan Catherine Walton
• Carson Russell Ward, MD
• Stephanie Warshaw, PHARMD

• Certified Registered Nurse Anesthetist in Jber, AK
• Providers in Jber, AK by specialty
• Certified Registered Nurse Anesthetist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.