Ms Tina Wallace, is a
Licensed Vocational Nurse based in Kenosha, Wisconsin. Ms Tina Wallace is licensed to practice in Wisconsin (license number 31662-31) and her current practice location is
4603 40th Ave, Kenosha, Wisconsin. She can be reached at her office (for appointments etc.) via phone at
(262) 914-1981.
NPI number for Ms Tina Wallace is 1326484056 and her current mailing address is 4603 40th Ave, Kenosha, Wisconsin. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1326484056.
Provider's Profile
| Full Name | Ms Tina Wallace |
|---|
| Gender | Female |
|---|
| Speciality | Licensed Vocational Nurse |
|---|
| Location | 4603 40th Ave, Kenosha, Wisconsin |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1326484056
- Provider Enumeration Date: 05/21/2013
- Last Update Date: 05/21/2013
Medical Identifiers
Medical identifiers for Ms Tina Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1326484056 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 164X00000X | Licensed Vocational Nurse | 31662-31 (Wisconsin) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ms Tina Wallace is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Ms Tina Wallace,
4603 40th Ave,
Kenosha, WI 53144-3543
Ph: (262) 914-1981 | Ms Tina Wallace,
4603 40th Ave,
Kenosha, WI 53144-3543
Ph: (262) 914-1981 |
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