Diane S Wallace
Emergency Medical Services
301 W Homer St
Michigan City
, Indiana 46360-4358
Diane S Wallace
Emergency Medical Services
301 W Homer St
Michigan City
, Indiana 46360-4358
(734) 995-3764
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About
Features
Specialties
- Emergency Medical Services
Languages spoken
- English
Location
First Address
- Diane S Wallace
- 2000 Green Rd Suite 300
- Ann Arbor, MI
- Zip : 48105-1598
- Phone : (734) 995-3764
Second Address
- Diane S Wallace
- 301 W Homer St
- Michigan City, IN
- Zip : 46360-4358
- Phone : (219) 879-8511
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FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207PE0004X | Emergency Medical Services | 01061919A | IN |
National Provider Identifier
| NPI | 1194764647 |
|---|---|
| Provider Name | Diane S Wallace |
| First Address | Ann Arbor, MI 48105-1598 |
| Second Address | Michigan City, IN 46360-4358 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 06/06/2006 |
| Last Update Date | 11/11/2014 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| J97944 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.