Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dana Marie Wallace, CRNPFNP-C

Individual provider Family Nurse Practitioner · NPI 1861989279

Dana Marie Wallace, CRNPFNP-C is a Nurse Practitioner in Philadelphia, Pennsylvania. Qualified in 2017, 9 years ago. Practices with Main Line Healthcare, a 1,153-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Pennsylvania.

Years since qualifying
9
Licensed in
PA
In the registry since
2018
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Practice location Address checks out

5040 City Ave
Philadelphia, PA 19131-1435
Phone: (215) 877-2116
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence SP018488 (PA)

Record details

NPI number1861989279
Entity typeIndividual (Type 1)
GenderFemale
Credentials CRNPFNP-C
Sole proprietorNo
NPI enumeratedApril 20, 2018
Last updated in NPPESApril 20, 2018

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Main Line Healthcare — 1153 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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