Look up the most recent NPI and PECOS records

Janell Mae Lorton Wallace

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

1000 E 1st St Ste 404, Duluth, MN 55805-2297

PECOS Enrollment

This provider is enrolled in PECOS as JANELL LORTON.

Based on the most recent information from CMS, provider Janell Mae Lorton Wallace is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1881204360
Provider Type
Individual
Full Name
Wallace, Janell Mae Lorton
Credential
PA-C

Gender
Female
Sole Proprietor
No
Enumeration Date
8/9/2020
Last Updated
7/17/2024

Contact Information

Practice Location

1000 E 1st St Ste 404, Duluth, MN 55805-2297

(218) 722-5513

Unlisted Fax

Mailing Location

1000 E 1st St, Ste 404, Duluth, MN 55805-2297

(952) 913-9930

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363AS0400X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 13693 Minnesota
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 13693 Minnesota

Janell Mae Lorton Wallace

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Burgstahler, Laura Lee

Baxley, Dennis Alvin

Johnson, Richard E

Hermes, Adam Tanner

Binek, Hakan

Wallace, Heather A

Dierker Birchhill, Erika Jayne

Hursh, Kayleigh

Andrews, Gary Lee