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

Mrs. Cynthia Wallace, AGPCNP

Individual provider Gerontology Nurse Practitioner · NPI 1811393648

Mrs. Cynthia Wallace, AGPCNP is a Nurse Practitioner in Medford, Oregon. Qualified in 2014, 12 years ago. Practices with Providence Health and Services Oregon, an 18-clinician group and accepts Medicare assignment. Licensed in Oregon.

Years since qualifying
12
Licensed in
OR
In the registry since
2014

Practice location Address checks out

1111 Crater Lake Ave
Medford, OR 97504-6241
Phone: (541) 732-5250
Fax: (541) 732-5251
Show map & directions

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

Specialties & licences

Gerontology Nurse Practitioner (primary) Taxonomy 363LG0600X · Licence 201500016NP-PP (OR)

Record details

NPI number1811393648
Entity typeIndividual (Type 1)
GenderFemale
Credentials AGPCNP
Sole proprietorNo
NPI enumeratedNovember 5, 2014
Last updated in NPPESSeptember 30, 2020
Certification dateSeptember 30, 2020

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Providence Health And Services Oregon — 18 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Medford