Donnetta Lynn Wallace

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R 151800-9 Issued in MN

Practice address

1001 Hart Blvd Ste 100
Monticello, MN 55362-8929

Phone

(763) 295-2921

Fax

(763) 581-9090

NPI assigned

Oct 29, 2013

Last updated

Nov 30, 2023By 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

• Donnetta Lynn Luebke Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Stellis Health, PAGroup PAC ID 1153233796, 54 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Centracare Health - Monticello Hospital, Monticello, MN, CCN 241362

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dwallace23322@direct.northmemorial.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Stellis Health, PA

  dba Buffalo Clinic, Monticello Clinic, Albertville/St.Michael Clinic,

  • Multi-Specialty Clinic/Center
  • Buffalo, MN
  • NPI 1184664674
  Medicare reassignment Care Compare group NPD
• Stellis Health, PA

  • Multi-Specialty Clinic/Center
  • Monticello, MN
  • NPI 1013103050
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Centracare Health System-NR LLC

  dba CentraCare Health - Monticello Hospital

  • Critical Access Hospital
  • Monticello, MN
  • NPI 1275872772
  Care Compare affiliation
• Centracare Health System-NR LLC

  dba CentraCare - Monticello Specialty Clinic

  • Multi-Specialty Clinic/Center
  • Monticello, MN
  • NPI 1558600874

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1383004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701302400000",
    "number": "1922436914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 HIGHWAY 25 N",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553131930",
            "telephone_number": "763-682-1313",
            "fax_number": "763-581-9090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 HART BLVD STE 100",
            "city": "MONTICELLO",
            "state": "MN",
            "postal_code": "553628929",
            "telephone_number": "763-295-2921",
            "fax_number": "763-581-9090"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1700 Highway 25 N",
            "address_purpose": "LOCATION",
            "city": "Buffalo",
            "state": "MN",
            "postal_code": "553131930",
            "country_code": "US",
            "telephone_number": "763-684-3678",
            "fax_number": "763-684-3790",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "DONNETTA",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-29",
        "last_updated": "2023-11-30",
        "certification_date": "2023-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R 151800-9",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dwallace23322@direct.northmemorial.com",
            "affiliation": "N",
            "address_1": "1001 Hart Blvd Ste 100",
            "city": "Monticello",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553628929",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "DONNETTA",
            "last_name": "LUEBKE",
            "middle_name": "LYNN",
            "credential": "LPN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Stephanie Van Beek, MS
• Janelle J. Vigil, LMFT
• Melissa Villeneuve, LPC
• Wal-Mart Stores, Inc. (Vision Center 30-3624)
• Walgreen Co (Walgreens #13938)
• Walmart Inc. (Walmart Pharmacy 10-3624)
• Madison Lea Walsh
• Kristin Marie Warmka
• Breann Wedin, MS, SLP
• Chad Welle, CRNA

• Family Nurse Practitioner in Monticello, MN
• Providers in Monticello, MN by specialty
• Family Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.