Leontine Wallace, RN, BSN - Registered Nurse in West Bloomfield, MI

Leontine Wallace, RN, BSN is a Registered Nurse - Lactation Consultant based in West Bloomfield, Michigan. Leontine Wallace is licensed to practice in Michigan (license number 4704318023) and her current practice location is 2300 Haggerty Rd Ste 2110, West Bloomfield, Michigan. She can be reached at her office (for appointments etc.) via phone at (248) 926-1420.

NPI number for Leontine Wallace is 1053800649 and her current mailing address is 2300 Haggerty Rd Ste 2110, West Bloomfield, Michigan. She does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1053800649.

Contact Information

Leontine Wallace, RN, BSN
2300 Haggerty Rd Ste 2110,
West Bloomfield, MI 48323-2191
(248) 926-1420
(248) 926-5338

Map and Direction




Provider's Profile

Full NameLeontine Wallace
GenderFemale
SpecialityRegistered Nurse - Lactation Consultant
Location2300 Haggerty Rd Ste 2110, West Bloomfield, Michigan
Accepts Medicare AssignmentsDoes not participate in Medicare Program. She may not accept medicare assignment.
  NPI Data:
  • NPI Number: 1053800649
  • Provider Enumeration Date: 05/09/2018
  • Last Update Date: 05/09/2018

Medical Identifiers

Medical identifiers for Leontine Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1053800649NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
163WP0200XRegistered Nurse - Pediatrics 4704318023 (Michigan)Secondary
163WL0100XRegistered Nurse - Lactation Consultant 4704318023 (Michigan)Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Leontine Wallace is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Leontine Wallace, RN, BSN
2300 Haggerty Rd Ste 2110,
West Bloomfield, MI 48323-2191

Ph: (248) 926-1420
Leontine Wallace, RN, BSN
2300 Haggerty Rd Ste 2110,
West Bloomfield, MI 48323-2191

Ph: (248) 926-1420

Reviews and Comments


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