1255681839 NPI number — DR. JULIE SCHROEDER WALLACE PH.D

Table of content: DR. JULIE SCHROEDER WALLACE PH.D (NPI 1255681839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255681839 NPI number — DR. JULIE SCHROEDER WALLACE PH.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALLACE
Provider First Name:
JULIE
Provider Middle Name:
SCHROEDER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255681839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 NW 193RD CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73012-3553
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-740-8800
Provider Business Mailing Address Fax Number:
405-657-2556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4334 NW EXPRESSWAY
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73116-1515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-740-8800
Provider Business Practice Location Address Fax Number:
405-657-2556
Provider Enumeration Date:
09/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  823 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com