Joan Wallace, NP

Primary specialty

Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X

License

NPP20834 Issued in RI

Practice address

297 Promenade St
Providence, RI 02908-5720

Phone

(401) 490-6464

NPI assigned

Oct 2, 2006

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

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": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192060800000",
    "number": "1972696938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "297 PROMENADE ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029085720",
            "telephone_number": "401-490-6464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "297 PROMENADE ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029085720",
            "telephone_number": "401-490-6464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JOAN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-02",
        "last_updated": "2007-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "RI",
            "license": "NPP20834",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bryce Wall, MD
• James Barta Wall, MD
• Gemma Wallace, PHD
• Jacqueline Wallace, RN
• Jailene Wallace, FNP-C
• Paul Michael Wallace, MD
• Nicholas Walle
• Ann Marie Wallick, CRNA
• Brittany Meaghan Wallin, CRNA
• Barbara Anne Walsh Egan

• Obstetrics & Gynecology Nurse Practitioner in Providence, RI
• Providers in Providence, RI by specialty
• Obstetrics & Gynecology Nurse Practitioner in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2007; 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.