| Lodica Wallace, | |
|
790 Drakeshire Dr, Commerce Twp, MI 48390-2981 | |
| (248) 910-2762 | |
| Not Available |
| Full Name | Lodica Wallace |
|---|---|
| Gender | Female |
| Speciality | Nurse Practitioner - Family |
| Location | 790 Drakeshire Dr, Commerce Twp, Michigan |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114587557 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LF0000X | Nurse Practitioner - Family | 2018023394 (Michigan) | Primary |
| Entity Name | Ascension Providence Hospital |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1942265236 PECOS PAC ID: 6103738703 Enrollment ID: O20031103000326 |
| Mailing Address | Practice Location Address |
|---|---|
| Lodica Wallace, 790 Drakeshire Dr, Commerce Twp, MI 48390-2981 Ph: () - | Lodica Wallace, 790 Drakeshire Dr, Commerce Twp, MI 48390-2981 Ph: (248) 910-2762 |
Megan Sparling, FNP-C Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 8800 Commerce Rd, Commerce Twp, MI 48382 Phone: 248-363-7500 Fax: 248-363-7700 | |
Miranda Yaldo, FNP-C Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 4057 Pioneer Dr Ste 300, Commerce Twp, MI 48390 Phone: 248-669-5050 Fax: 248-669-1700 | |
Daryl Kaye Wilson, Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 524 Addison Cir, Commerce Twp, MI 48390 Phone: 602-920-4171 | |
Patricia Ann Atkins, NNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 5473 Hillsboro Ct, Commerce Twp, MI 48382 Phone: 847-530-3353 | |
Tobechukwu Anthonia Unaegbu, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 2852 Ivy Hill Dr, Commerce Twp, MI 48382 Phone: 248-574-1878 | |
Lindsay Rutland, CPNP-PC Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 8896 Commerce Rd Ste 5, Commerce Twp, MI 48382 Phone: 248-360-9241 |