Active NPI
Carrie Esther Wallace, PA
- Physician Assistant
- Grand Forks, ND
National Provider Identifier
1851614739
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 995
- Practice address
- 1000 S Columbia Rd
Grand Forks, ND 58201-4032 - Phone
- (701) 780-5000
- NPI assigned
- Mar 8, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 995 | ND | Primary |
Addresses
Primary practice location
1000 S Columbia Rd
Grand Forks, ND 58201-4032
Mailing address
1000 S Columbia Rd
PO Box 6002
Grand Forks, ND 58201-4032
Phone (701) 780-5000
Other names 1
- Carrie Esther Iverson
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 995 | ND | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268006400000",
"number": "1851614739",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 S COLUMBIA RD",
"address_2": "PO BOX 6002",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "582014032",
"telephone_number": "701-780-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 S COLUMBIA RD",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "582014032",
"telephone_number": "701-780-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "CARRIE",
"middle_name": "ESTHER",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-03-08",
"last_updated": "2010-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "ND",
"license": "995",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "CARRIE",
"last_name": "IVERSON",
"middle_name": "ESTHER",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Grand Forks, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.