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Dr. Dane C Wallace, NURSEPRACTITIONER
Family Nurse Practitioner in Edwardsville, Illinois
NPI 1528787744

Dane C Wallace is a Family Nurse Practitioner based in Edwardsville, IL and is specialized in Family. Dane C Wallace practices in Edwardsville, IL and has the professional credentials of NURSEPRACTITIONER. The NPI Number for Dane C Wallace is 1528787744 and holds a License No. 209.025563 (Illinois).

The current practice location address for Dane C Wallace is 529 Hillsboro Ave, Edwardsville, IL and can be reached out via phone at 217-621-8675.

Location: 529 Hillsboro Ave, Edwardsville, IL, 62025-1864
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1528787744
Provider Name
Dane C Wallace
Credential
NURSEPRACTITIONER
Provider Entity Type
Individual
Gender
Male
Address
529 Hillsboro Ave, Edwardsville, IL, 62025-1864
Phone Number
217-621-8675
Fax Number
Provider Enumeration Date
08/22/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
529 Hillsboro Ave
City
Edwardsville
State
Illinois
Zip
62025-1864
Phone Number
217-621-8675
Fax Number
person
Provider Business Mailing Address Details
Address
529 Hillsboro Ave
City
Edwardsville
State
Illinois
Zip
62025-1864
Phone Number
217-621-8675
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
363LF0000X
License No.
209.025563 (Illinois)
Definition
Definition to come...
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