MRS. CYNTHIA WALLACE AGPCNP NPI 1811393648

NPI Information

NPI: 1811393648
Provider Name: MRS. CYNTHIA WALLACE, AGPCNP
Classification: Nurse Practitioner - 363LG0600X
Entity Type: Individual

Specialization: Gerontology

Organization: PROVIDENCE HEALTH AND SERVICES OREGON

PECOS Registration: Yes

Address:
1111 CRATER LAKE AVE
MEDFORD, OR
ZIP 97504
Phone: (541) 732-5250
Get Directions

MRS. Cynthia Wallace, AGPCNP is a gerontology nurse practitioner in Medford, OR with 10 years of experience. MRS. Cynthia Wallace, AGPCNP NPI is 1811393648. 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:

1111 CRATER LAKE AVE
MEDFORD, OR
ZIP 97504-241
Phone: (541) 732-5250
Fax: (541) 732-5251

The NPI 1811393648 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 11/5/2014 and was last updated on 9/30/2020.

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	363LG0600X	Nurse Practitioner	Gerontology	201500016NP-PP	OREGON	Yes

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »