1689110918 NPI number — MRS. JAMIE RENEE' WALLACE RN, BSN

Table of content: MRS. JAMIE RENEE' WALLACE RN, BSN (NPI 1689110918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689110918 NPI number — MRS. JAMIE RENEE' WALLACE RN, BSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALLACE
Provider First Name:
JAMIE
Provider Middle Name:
RENEE'
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, BSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BORDER
Provider Other First Name:
JAMIE
Provider Other Middle Name:
RENEE'
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, BSN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689110918
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 - HOSPITAL DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOVER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-343-6631
Provider Business Mailing Address Fax Number:
330-343-8188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 - HOSPITAL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-343-6631
Provider Business Practice Location Address Fax Number:
330-343-8188
Provider Enumeration Date:
01/10/2017

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: 163W00000X , with the licence number:  RN.287814 , registered in the state of OH ; 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