Provider Demographics
NPI:1124475439
Name:WALLACE, MARGARET LEIGH (APRN)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:LEIGH
Last Name:WALLACE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:HEGGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:8141 W CENTER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3273
Mailing Address - Country:US
Mailing Address - Phone:402-717-3000
Mailing Address - Fax:402-717-3030
Practice Address - Street 1:8141 W CENTER RD STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3273
Practice Address - Country:US
Practice Address - Phone:402-717-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE70142163W00000X
NE112093363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse