LAURY M WALLACE NP NPI 1205343845

NPI Information

NPI: 1205343845
Provider Name: LAURY M WALLACE, NP
Classification: Family Medicine - 207QA0505X
Entity Type: Individual

Specialization: Adult Medicine

PECOS Registration: Yes

Address:
16731 GAITHER BLVD
WESTFIELD, IN
ZIP 46074
Phone: (317) 561-6840
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Laury M Wallace, NP is an adult medicine family medicine in Westfield, IN. The provider is the National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code. Laury M Wallace, NP NPI is 1205343845. 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:

16731 GAITHER BLVD
WESTFIELD, IN
ZIP 46074-607
Phone: (317) 561-6840
Fax: (812) 239-3771

The NPI 1205343845 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 1/4/2018 and was last updated on 1/4/2018.

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	207QA0000X	Family Medicine	Adolescent Medicine	71007724A	INDIANA	No
2	207QA0505X	Family Medicine	Adult Medicine	71007724A	INDIANA	Yes
3	207QG0300X	Family Medicine	Geriatric Medicine	71007724A	INDIANA	No
4	207QH0002X	Family Medicine	Hospice and Palliative Medicine	71007724A	INDIANA	No

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: 5/5/2024

NPI Synchronization or Removal

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