GERALD ADRIAN WALLACE (CRNA) – Registered Nurse, NPI 1265478416
Excluded from federal healthcare programs (Medicare/Medicaid)
This provider is listed on the OIG List of Excluded Individuals/Entities (LEIE). Exclusion effective: 2015-01-20. Reason: License revocation, suspension, or surrender.
Registered Nurse
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for GERALD ADRIAN WALLACE (CRNA)
4008, Southeast Willamette Drive, Glen Echo, Portland, Metro, Clackamas County, Oregon, 97267, United States
PORTLAND, OR 972084008
Phone: (503) 372-2740
Fax: (503) 372-2754
Type: Mailing
Saint Charles Medical Center Redmond, 1253, Northwest Canal Boulevard, Redmond, Deschutes County, Oregon, 97756, United States
REDMOND, OR 977561334
Phone: (541) 584-8131
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 97208)
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