Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jennifer Marie Wallace, NURSEPRACTITIONER

Individual provider Gerontology Nurse Practitioner · NPI 1790412591

Jennifer Marie Wallace, NURSEPRACTITIONER is a Nurse Practitioner in Deptford, New Jersey. Qualified in 2022, 4 years ago. Practices with Nurse Practitioner Professional Resources, a 13-clinician group, works from 3 locations, accepts Medicare assignment and offers telehealth. Licensed in New Jersey.

Years since qualifying
4
Licensed in
NJ
In the registry since
2022

Practice location Address checks out

202 Cabot Ct
Deptford, NJ 08096-5114
Phone: (856) 885-4579
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 36 Walker Rd, West Orange, NJ 07052-4403 — (973) 715-5586
  • 36 Walker Rd, West Orange, NJ 07052-4403 — (973) 715-5586

Specialties & licences

Gerontology Nurse Practitioner (primary) Taxonomy 363LG0600X · Licence 26NJ01341100 (NJ)

Record details

NPI number1790412591
Entity typeIndividual (Type 1)
GenderFemale
Credentials NURSEPRACTITIONER
Sole proprietorNo
NPI enumeratedAugust 2, 2022
Last updated in NPPESAugust 2, 2022
Certification dateAugust 2, 2022

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Nurse Practitioner Professional Resources — 13 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare