Tereasa Anne Wallace, RN, MN

Primary specialty

Maternal Newborn Registered NurseTaxonomy code 163WM0102X

License

92415 Issued in CO

Practice address

1333 Iris Ave
Boulder, CO 80304-2226

Phone

(303) 443-8500

Fax

(720) 406-3664

NPI assigned

Apr 6, 2011

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)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1302048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302048000000",
    "number": "1982993366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 IRIS AVE",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803042226",
            "telephone_number": "720-562-0566",
            "fax_number": "720-406-3664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 IRIS AVE",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803042226",
            "telephone_number": "303-443-8500",
            "fax_number": "720-406-3664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "TEREASA",
        "middle_name": "ANNE",
        "credential": "RN, MN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-06",
        "last_updated": "2011-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WM0102X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Maternal Newborn",
            "state": "CO",
            "license": "92415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer A Wallace, M.A., L.P.C.
• Jessica Wallace
• Julie Lyn Wallace, LPCC
• Lisa Wallace, LPC
• Mary Louise Wallace, MA, CCC-SLP
• Cathrine Skogheim Walle, D.C., B.S.
• Katherine Eleanor Waller
• Lauren Alexandra Waller, LCSW
• Meredith Ann Waller, LCSW
• Ruth Stephanie Waller, P.T.

• Maternal Newborn Registered Nurse in Boulder, CO
• Providers in Boulder, CO by specialty
• Maternal Newborn Registered Nurse in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2011; 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.