Individual provider · Type 1 NPI

Gerald Adrian Wallace, CRNA

Registered Nurse · Redmond, OR

NPI number 1265478416 Active

Practice location

1253 NW Canal Blvd
Redmond, OR 97756-1334

Mailing address

PO Box 4008
Portland, OR 97208-4008

Specialties and licenses

TaxonomyCodeLicense
Registered Nurse Primary 163W00000XNone listed
Certified Registered Nurse Anesthetist 367500000XNone listed

Registered Nurse: (1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive either a diploma from a hospital program, an associate degree in nursing (A.D.N.) or a Bachelor of Science degree in nursing (B.S.N.), who is licensed or certified by the state, and is practicing within the scope of that license or certification. R.N.'s assist patient…

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About NPI 1265478416

Gerald Adrian Wallace, CRNA's National Provider Identifier is 1265478416, issued on Jun 22, 2006. The primary taxonomy on file is Registered Nurse (163W00000X), and the practice location is in Redmond, OR. The record was last updated on Sep 11, 2025.