Active NPI
Amy Beth Wallace, LPN
- Licensed Practical Nurse
- Henrietta, NY
National Provider Identifier
1861663122
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 276860
- Practice address
- 150 Gate House TRL
Henrietta, NY 14467-9559 - Phone
- (585) 359-3557
- NPI assigned
- Mar 14, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 276860 | NY | Primary |
Addresses
Primary practice location
150 Gate House TRL
Henrietta, NY 14467-9559
Mailing address
150 Gate House TRL
Henrietta, NY 14467-9559
Phone (585) 359-3557
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02570267 | Medicaid | NY |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 276860 | NY | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205452800000",
"number": "1861663122",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 GATE HOUSE TRL",
"city": "HENRIETTA",
"state": "NY",
"postal_code": "144679559",
"telephone_number": "585-359-3557"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 GATE HOUSE TRL",
"city": "HENRIETTA",
"state": "NY",
"postal_code": "144679559",
"telephone_number": "585-359-3557"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "AMY",
"middle_name": "BETH",
"name_prefix": "Mrs.",
"credential": "LPN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-03-14",
"last_updated": "2008-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NY",
"license": "276860",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02570267",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Henrietta, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 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.