MEDICARE: RICHARD WALLACE RN BSN

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	163W00000X	Registered Nurse	112239	CO

General Provider Information

NPI Number	:	1811434400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD WALLACE RN BSN

Provider Business Mailing Address
First Line	:	4905 HACKAMORE DR N
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-2632
Country	:	US
Telephone Number	:	719-252-6631
Fax Number	:

Provider Business Practice Location Address
First Line	:	4905 HACKAMORE DR N
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-2632
Country	:	US
Telephone Number	:	719-252-6631
Fax Number	:

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

Provider Enumeration Date	:	01/20/2017
Last Update Date	:	01/20/2017

Similar Medicare Providers

1114868361 — SARAH KOLLER MA, LPC
Practice Location Address:

7222 COMMERCE CENTER DR STE 255
COLORADO SPRINGS, CO
80919-2632

Practice Phone: 719-426-2381
Practice Fax:

1194334169 — JILL TULLMAN & ASSOCIATES, LLC
Practice Location Address:

7222 COMMERCE CENTER DR STE 255
COLORADO SPRINGS, CO
80919-2632

Practice Phone: 303-284-4021
Practice Fax:

1679897789 — EMILY MABERRY
Practice Location Address:

930 W COLORADO BLVD
DALLAS, TX
75208-2632

Practice Phone: 214-415-8025
Practice Fax:

1588720684 — DR. TY CHARLES QUICKENDEN D.C.
Practice Location Address:

2632 FOOTHILL BLVD , SUITE 107
ROCK SPRINGS, WY
82901-4756

Practice Phone: 307-362-7900
Practice Fax: 307-362-8230

1982759205 — MRS. KARLA ANN CARNAHAN M.S., CCC, SLP-L
Practice Location Address:

2632 FOOTHILL BLVD , SUITE 104
ROCK SPRINGS, WY
82901-4756

Practice Phone: 307-389-7434
Practice Fax:

1609043223 — DR. LARRY JAMES CARLSON PH.D
Practice Location Address:

2632 FOOTHILL BLVD , SUITE 106
ROCK SPRINGS, WY
82901-4756

Practice Phone: 307-362-8840
Practice Fax: 307-362-8840

Directions to “ RICHARD WALLACE RN BSN” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.