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Lizabeth Wallace
Nurse Practitioner in Peoria, Illinois
NPI 1417019084

Lizabeth Wallace is a Nurse Practitioner based in Peoria, IL. Lizabeth Wallace practices in Peoria, IL. The NPI Number for Lizabeth Wallace is 1417019084 and holds a License No. 0411285741-209004409 (Illinois).

The current practice location address for Lizabeth Wallace is 420 Ne Glen Oak Ave, Peoria, IL and can be reached out via phone at 309-655-2343 and via fax at 309-655-3948.

Location: 420 Ne Glen Oak Ave, Peoria, IL, 61603-3105
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1417019084
Provider Name
Lizabeth Wallace
Credential
Provider Entity Type
Individual
Gender
Female
Address
420 Ne Glen Oak Ave, Peoria, IL, 61603-3105
Phone Number
309-655-2343
Fax Number
309-655-3948
Provider Enumeration Date
12/13/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
207594001 01 IL MEDICARE INDIVIDUAL ID/K35369 DEACTIVATED
institution
Provider Business Practice Location Address Details
Address
420 Ne Glen Oak Ave
City
Peoria
State
Illinois
Zip
61603-3105
Phone Number
309-655-2343
Fax Number
309-655-3948
person
Provider Business Mailing Address Details
Address
420 Ne Glen Oak Ave
City
Peoria
State
Illinois
Zip
61603-3105
Phone Number
309-655-2343
Fax Number
309-655-3948
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
-
Taxonomy
363L00000X
License No.
0411285741-209004409 (Illinois)
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
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