MEDICARE: MS. JANET ANN WALLACE CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	COA 05893	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235237819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANET ANN WALLACE CNP

Provider Business Mailing Address
First Line	:	1129 NORRIS DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-2734
Country	:	US
Telephone Number	:	614-262-7758
Fax Number	:

Provider Business Practice Location Address
First Line	:	1699 W MOUND ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43223-1809
Country	:	US
Telephone Number	:	614-263-5006
Fax Number	:	614-263-5019

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	03/12/2010

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