Lisa Ann Wallace

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

4703086959 Issued in MI

Practice address

8700 Mosherville Rd
Horton, MI 49246-9601

Phone

(517) 358-5830

NPI assigned

Apr 17, 2019

Sex

Female

Sole proprietor

No

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

• Care That Matters Home Health Care LLC

  • Home Health Agency
  • Jackson, MI
  • NPI 1710746987
  NPD Authorized official

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 12, 2023.

{
    "created_epoch": "1555459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702339200000",
    "number": "1992368872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8700 MOSHERVILLE RD",
            "city": "HORTON",
            "state": "MI",
            "postal_code": "492469601",
            "telephone_number": "517-358-5830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8700 MOSHERVILLE RD",
            "city": "HORTON",
            "state": "MI",
            "postal_code": "492469601",
            "telephone_number": "517-358-5830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "LISA",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-17",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MI",
            "license": "4703086959",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Hatch
• Autumn Cheryl Putnam
• Kaylynn Toler
• Teresa Maria Tucker
• Michelle Walker, CNP
• Nicole Woods

• All providers in Horton, MI
• Licensed Practical Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; 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.