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

Stephanie Wallace, APRNCNP

Individual provider Family Nurse Practitioner · NPI 1194416792

Stephanie Wallace, APRNCNP is a Nurse Practitioner in Independence, Ohio. Qualified in 2021, 5 years ago. Practices with Northcoast Dermatology Associates, Inc, a 5-clinician group and accepts Medicare assignment. Licensed in Ohio.

Years since qualifying
5
Licensed in
OH
In the registry since
2023

Practice location Address checks out

4807 Rockside Rd Ste 100
Independence, OH 44131-2188
Phone: (216) 524-4009
Show map & directions

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

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence APRN.CNP.0030395 (OH)

Record details

NPI number1194416792
Entity typeIndividual (Type 1)
GenderFemale
Credentials APRNCNP
Sole proprietorNo
NPI enumeratedMay 16, 2023
Last updated in NPPESNovember 17, 2025
Certification dateNovember 17, 2025
Mailing address4807 Rockside Rd Ste 100, Independence, OH 44131-2188

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Northcoast Dermatology Associates, Inc. — 5 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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