Jessica Nicole Wallace, RN
Individual provider Active NPI Registered Nurse · Middleport, OH
NPI 1689846164 · NPPES record last updated Mar 25, 2008
Key facts
- NPI
- 1689846164
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- SL987156 (OH)
- Practice address
- 655 Front St
Middleport, OH 45760 - Phone
- (740) 416-5643
- NPI assigned
- Mar 25, 2008
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SL987156 | OH | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | SL987156 | OH | Yes |
Addresses
Primary practice location
655 Front St
Middleport, OH 45760
Mailing address
655 Front St
Middleport, OH 45760
Phone (740) 416-5643
Other names
- Miss Jessica Nicole Cale
Other providers in Middleport, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.