DR. TAMARA JANE WALLACE NP NPI 1073780045

NPI Information

NPI: 1073780045
Provider Name: DR. TAMARA JANE WALLACE, NP
Classification: Nurse Practitioner - 363LN0000X
Entity Type: Individual

Specialization: Neonatal

Address:
700 CHILDRENS DR
COLUMBUS, OH
ZIP 43205
Phone: (614) 361-8430
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DR. Tamara Jane Wallace, NP is a neonatal nurse practitioner in Columbus, OH. DR. Tamara Jane Wallace, NP NPI is 1073780045. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

700 CHILDRENS DR
COLUMBUS, OH
ZIP 43205-664
Phone: (614) 361-8430

The enumeration date for this NPI number is 5/9/2008 and was last updated on 1/4/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LN0000X	Nurse Practitioner	Neonatal	APN0000015454	TENNESSEE	No
2	363LN0000X	Nurse Practitioner	Neonatal	01255	OHIO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	4299578	OTHER	TENNESSEE	TNCARE BLCARE
2	129252	MEDICAID	ALABAMA
3	606646	OTHER		WELL CARE
4	003109104C	MEDICAID	GEORGIA
5	003109104C	OTHER	GEORGIA	AMERIGROUP GA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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