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

Miata Wallace, PA

Individual provider Physician Assistant · NPI 1013656990

Miata Wallace, PA is a Physician Assistant in Lincoln, Nebraska. Qualified in 2022, 4 years ago. Practices with Nebraska Pulmonary Specialties LLC, a 28-clinician group and accepts Medicare assignment. Licensed in Nebraska.

Years since qualifying
4
Licensed in
NE
In the registry since
2022
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1500 S 58th St Ste 800
Lincoln, NE 68506-1407
Phone: (402) 483-8600
Fax: (402) 483-8689
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 2760 (NE)

Record details

NPI number1013656990
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedMay 31, 2022
Last updated in NPPESMarch 25, 2025
Certification dateMarch 25, 2025
Mailing address1500 S 58th St Ste 800, Lincoln, NE 68506-1407

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Nebraska Pulmonary Specialties Llc — 28 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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