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Kathryn Mary Wallace, APRN,BC
Nurse Practitioner in Portage, Indiana
NPI 1407965320

Kathryn Mary Wallace is a Nurse Practitioner based in Portage, IN. Kathryn Mary Wallace practices in Portage, IN and has the professional credentials of APRN,BC. The NPI Number for Kathryn Mary Wallace is 1407965320 and holds a License No. 71000473A (Indiana).

The current practice location address for Kathryn Mary Wallace is 2640 Hamstrom Rd, Portage, IN and can be reached out via phone at 219-762-4423 and via fax at 219-763-3120. You can also correspond with Kathryn Mary Wallace through the mailing address at 2640 HAMSTROM RD, PORTAGE, IN - 46368-3832 (mailing address contact number: 219-762-4423).

Location: 2640 Hamstrom Rd, Portage, IN, 46368-3832
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1407965320
Provider Name
Kathryn Mary Wallace
Credential
APRN,BC
Provider Entity Type
Individual
Gender
Female
Address
2640 Hamstrom Rd, Portage, IN, 46368-3832
Phone Number
219-762-4423
Fax Number
219-763-3120
Provider Enumeration Date
08/30/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
200056120A 05 IN
500004228 01 IN RAILROAD MEDICARE
institution
Provider Business Practice Location Address Details
Address
2640 Hamstrom Rd
City
Portage
State
Indiana
Zip
46368-3832
Phone Number
219-762-4423
Fax Number
219-763-3120
person
Provider Business Mailing Address Details
Address
2640 Hamstrom Rd
City
Portage
State
Indiana
Zip
46368-3832
Phone Number
219-762-4423
Fax Number
219-763-3120
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
-
Taxonomy
363L00000X
License No.
71000473A (Indiana)
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
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