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MARY RUTH WALLIS
NPI 1790430650
Licensed Practical Nurse in Eaton, NY

Active since February 18, 2022
2516 CANDY LN LOT 17, EATON, NY 13334(315) 679-1638 Get Directions Write a Review

NPPES record last updated: February 18, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mary Ruth Wallis NPPES

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

MARY RUTH WALLIS (NPI 1790430650) is an individual licensed practical nurse in Eaton, New York, licensed in New York (332738) and active in the NPI registry since February 2022.

NPPES Registry Identity

NPI1790430650
Entity TypeIndividualFemale
Primary Taxonomy164W00000X
Provider Legal NameMARY RUTH WALLIS
Location Address2516 CANDY LN LOT 17Eaton, NY 13334-3286
Mailing Address2516 Candy Ln Lot 17Eaton, NY 13334-3286 · (315) 679-1638
Phone(315) 679-1638
Sole ProprietorYes
Enumeration DateFebruary 18, 2022
NPPES CertifiedFebruary 18, 2022
✔ NPI 1790430650 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyLicensed Practical NurseNursing Service Providers
Taxonomy Code164W00000X
License✔ Licensed in NY · 332738
Definition
A licensed practical nurse with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.
2516 CANDY LN LOT 17, Eaton, NY 13334
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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 Mary Wallis's NPI number?

The NPI number for Mary Wallis is 1790430650. It was assigned to this individual provider in the NPPES registry on February 18, 2022.

Where is Mary Wallis located?

Mary Wallis practices at 2516 Candy Ln Lot 17, Eaton, NY 13334. The listed phone number is (315) 679-1638.

What is Mary Wallis's specialty?

The primary specialty registered for this NPI is Licensed Practical Nurse with taxonomy code 164W00000X.

When was this NPI record last updated?

The NPPES record for Mary Wallis was last updated on February 18, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.