Carrie Leigh Wallace, FNP
Nurse Practitioner, Family in Orange, CA. Individual provider (NPI-1).
NPI number1265648596
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1265648596
- Entity type
- Individual (NPI-1)
- Name
- Miss Carrie Leigh Wallace
- Credential
- FNP
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- May 15, 2007
- Last updated
- Jul 8, 2007
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 13730 | CA | Yes |
Practice location
455 S Main StOrange, CA 92868-3835
Phone 714-289-4934
Mailing address
19001 Fairhaven ExtSanta Ana, CA 92705-1359
Phone 714-633-8187
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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