Active NPI
Dala Wallace
- Registered Nurse
- Omaha, NE
National Provider Identifier
1871914739
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 48189
- Practice address
- 12565 W Center Rd
Suite 100
Omaha, NE 68144-3802 - Phone
- (402) 342-5566
- Fax
- (402) 342-0034
- NPI assigned
- Dec 19, 2013
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 48189 | NE | Primary |
Addresses
Primary practice location
12565 W Center Rd
Suite 100
Omaha, NE 68144-3802
Mailing address
12565 W Center Rd
Suite 100
Omaha, NE 68144-3802
Phone (402) 342-5566
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 |
|---|---|---|---|
| 48189 | NE | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1387411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1387411200000",
"number": "1871914739",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12565 W CENTER RD",
"address_2": "SUITE 100",
"city": "OMAHA",
"state": "NE",
"postal_code": "681443802",
"telephone_number": "402-342-5566",
"fax_number": "402-342-0034"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12565 W CENTER RD",
"address_2": "SUITE 100",
"city": "OMAHA",
"state": "NE",
"postal_code": "681443802",
"telephone_number": "402-342-5566",
"fax_number": "402-342-0034"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "DALA",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-12-19",
"last_updated": "2013-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NE",
"license": "48189",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 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.