IndividualActive
Cynthia Wallace, AGPCNP
NPI 1811393648 · Gerontology Nurse Practitioner · Medford, OR
Provider details
- NPI number
- 1811393648
- Entity type
- Individual
- Primary specialty
- Gerontology Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- AGPCNP
- Sex
- Female
- Sole proprietor
- No
- License
- 201500016NP-PP (OR)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
1111 Crater Lake Ave
Medford, OR 97504-6241
Phone: (541) 732-5250
Fax: (541) 732-5251
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 3308
Portland, OR 97208-3308
Registry dates
- Enumerated
- 2014-11-05
- Last updated
- 2020-09-30
- Certified
- 2020-09-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.