Thomasena Sarahdetta Waller, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

00049712 Issued in SC

Practice address

701 Grove Rd
Greenville, SC 29605-4210

Phone

(864) 455-7000

NPI assigned

Sep 23, 2013

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

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1379894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379894400000",
    "number": "1679909659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 LAUREL VIEW LN",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296074740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 GROVE RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054210",
            "telephone_number": "864-455-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "THOMASENA",
        "middle_name": "SARAHDETTA",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-23",
        "last_updated": "2013-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "SC",
            "license": "00049712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Raymond Wallace, DMD
• Mary Margaret Wallach, RD, LD
• Carol F Wallen, R. PH
• Catherine Wallenborn, LISW-CP
• Lee Waller, PHARM.D.
• Blake Wallert, PT, DPT
• Alina Marie Wallin, OT
• Jay David Walls, MD
• Brian Patrick Walsh
• Brittany Walsh, M.D.

• Registered Nurse in Greenville, SC
• Providers in Greenville, SC by specialty
• Registered Nurse in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2013; 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.