STACY WALLACE NPI 1386264109

NPI Information

NPI: 1386264109
Provider Name: STACY WALLACE
Classification: Driver - 172A00000X
Entity Type: Individual
Address:
324 KENILWORTH AVE
TOLEDO, OH
ZIP 43610
Phone: (419) 810-0900
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Stacy Wallace is a driver in Toledo, OH. The provider is a person employed to operate a motor vehicle as a carrier of persons or property. Stacy Wallace NPI is 1386264109. 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:

324 KENILWORTH AVE
TOLEDO, OH
ZIP 43610-456
Phone: (419) 810-0900

The enumeration date for this NPI number is 4/22/2020 and was last updated on 4/22/2020.

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	172A00000X	Driver		RX730744	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	85052075	MEDICAID	OHIO

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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