MS. BONNIE MERRITT WALLACE PA-C
NPI 1437402229
Physician Assistant in Portage, MI

Active since October 18, 2012
3304 COOLEY CT, PORTAGE, MI 49024(269) 349-2266(269) 349-0792 Get Directions Write a Review

NPPES record last updated: October 12, 2014. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Ms. Bonnie Merritt Wallace Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. BONNIE MERRITT WALLACE PA-C (NPI 1437402229) is an individual physician assistant in Portage, Michigan, licensed in Michigan (5601006513) and active in the NPI registry since October 2012.

NPPES Registry Identity

NPI1437402229
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameMS. BONNIE MERRITT WALLACECredential: PA-C
Location Address3304 COOLEY CTPortage, MI 49024-7430
Mailing Address3304 Cooley CtPortage, MI 49024-7430 · (269) 349-2266 · Fax (269) 349-0792
Fax(269) 349-0792
Sole ProprietorNo
Enumeration DateOctober 18, 2012
Last NPPES UpdateOctober 12, 2014
NPI 1437402229 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License Licensed in MI · 5601006513
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
3304 COOLEY CT, Portage, MI 49024

Other Identifiers 4

Other1417961137MI · Bcbsm - Bmh
Medicare PINC97618363 - BMHMI
Other5601006513MI · Physician's Assistant License
Medicaid1437402229MI

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Internal Medicine (Gastroenterology)
3304 COOLEY CT
PORTAGE, MI 49024
Physician Assistant
3304 COOLEY CT
PORTAGE, MI 49024
Nurse Practitioner
3304 COOLEY CT
PORTAGE, MI 49024
Internal Medicine (Gastroenterology)
3304 COOLEY CT
PORTAGE, MI 49024
Nurse Practitioner (Family)
3304 COOLEY CT
PORTAGE, MI 49024
Nurse Practitioner
3304 COOLEY CT
PORTAGE, MI 49024
Internal Medicine (Gastroenterology)
3304 COOLEY CT
PORTAGE, MI 49024
Internal Medicine (Gastroenterology)
3304 COOLEY CT
PORTAGE, MI 49024

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Bonnie Wallace's NPI number?

The NPI number for Bonnie Wallace is 1437402229. It was assigned to this individual provider in the NPPES registry on October 18, 2012.

Where is Bonnie Wallace located?

Bonnie Wallace practices at 3304 Cooley Ct, Portage, MI 49024. The listed phone number is (269) 349-2266.

What is Bonnie Wallace's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

When was this NPI record last updated?

The NPPES record for Bonnie Wallace was last updated on October 12, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.