Wallace, Gerald Adrian

Wallace, Gerald Adrian is an individual health care provider with primary practice located at 1253 Nw Canal Blvd , Redmond OR 97756-1334. He recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered. Nursing Service Providers / Registered Nurse is his primary health care specialty. Wallace, Gerald Adrian can be contacted via phone (541) 584-8131.

Contact Information

Primary practice address
1253 Nw Canal Blvd Redmond OR 97756-1334
Phone: (541) 584-8131
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X Oregon
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X Oregon

Profile Details

NPI number 1265478416
LBN Legal business name Wallace, Gerald Adrian
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 22nd, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265478416 NPPES
Oregon MEDICAID 029121

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