Angie Marie Wallace, CRNP

Primary specialty

Pediatric Clinical Nurse SpecialistTaxonomy code 364SP0200X

License

SP009803 Issued in PA

Practice address

45 Roadside Ave FRNT
Waynesboro, PA 17268-2543

Phone

(717) 387-8060

Fax

(717) 387-8061

NPI assigned

Jul 2, 2008

Last updated

Sep 11, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Angie Marie Borne Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

{
    "created_epoch": "1214956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505088000000",
    "number": "1881856615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 ST PAUL DR STE 200",
            "city": "CHAMBERSBURG",
            "state": "PA",
            "postal_code": "172011033",
            "telephone_number": "717-709-7922",
            "fax_number": "717-263-2055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 ROADSIDE AVE FRNT",
            "city": "WAYNESBORO",
            "state": "PA",
            "postal_code": "172682543",
            "telephone_number": "717-387-8060",
            "fax_number": "717-387-8061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ANGIE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-02",
        "last_updated": "2017-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SP0200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Pediatrics",
            "state": "PA",
            "license": "SP009803",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGIE",
            "last_name": "BORNE",
            "middle_name": "MARIE",
            "prefix": "MISS",
            "credential": "CRNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Pediatric Clinical Nurse Specialist in Waynesboro, PA
• Providers in Waynesboro, PA by specialty
• Pediatric Clinical Nurse Specialist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2017; 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.