Mindy Lee Wallace, RD LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

164003636 Issued in IL

Practice address

935 Jersey St
Quincy, IL 62301-4030

Phone

(217) 228-2413

Fax

(217) 228-2416

NPI assigned

Jul 28, 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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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.

• Nutrition Solutions of Quincy, Inc.

  • Registered Dietitian
  • Coatsburg, IL
  • NPI 1104944230

  Dietitian, Registered

  NPD (past)

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222041600000",
    "number": "1851305304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2820 E BLUFF CT",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623051329",
            "telephone_number": "217-440-6458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "935 JERSEY ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623014030",
            "telephone_number": "217-228-2413",
            "fax_number": "217-228-2416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MINDY",
        "middle_name": "LEE",
        "name_prefix": "Ms.",
        "credential": "RD LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-28",
        "last_updated": "2008-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164003636",
            "primary": true
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MO",
            "license": "2005004105",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD IL",
            "identifier": "00132009",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUINCY HEALTH CARE MANAGE",
            "identifier": "075113",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gerald E Walker, MA LCPC NCC
• Jennifer L Walker
• Matthew Scott Walker, DNP, APRN, CNP
• Morgan Walker, LPN
• Ernest Wallace, MD
• Walmart Inc.
• Amanda Jean Wand, AU.D.
• Katy Marie Wand, MD
• Katie Kaimeng Wang, MD
• Kevin Wang, DO

• Registered Dietitian in Quincy, IL
• Providers in Quincy, IL by specialty
• Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2008; 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.