person
Deanna Wallace, NP
Family Nurse Practitioner in Decatur, Illinois
NPI 1609222579

Deanna Wallace is a Family Nurse Practitioner based in Decatur, IL and is specialized in Family. Deanna Wallace practices in Decatur, IL and has the professional credentials of NP. The NPI Number for Deanna Wallace is 1609222579 and holds a License No. 209.014278 (Illinois).

The current practice location address for Deanna Wallace is 1770 E Lake Shore Dr Ste 105, Decatur, IL and can be reached out via phone at 217-422-6100 and via fax at 833-784-5326. You can also correspond with Deanna Wallace through the mailing address at 1770 E LAKE SHORE DR STE 105, DECATUR, IL - 62521-3800 (mailing address contact number: 217-422-6100).

Location: 1770 E Lake Shore Dr Ste 105, Decatur, IL, 62521-3800
person
Provider Profile Details
NPI Number
1609222579
Provider Name
Deanna Wallace
Credential
NP
Provider Entity Type
Individual
Gender
Female
Address
1770 E Lake Shore Dr Ste 105, Decatur, IL, 62521-3800
Phone Number
217-422-6100
Fax Number
833-784-5326
Provider Enumeration Date
05/10/2016
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
P01657319 01 IL RAILROAD
institution
Provider Business Practice Location Address Details
Address
1770 E Lake Shore Dr Ste 105
City
State
Zip
62521-3800
Phone Number
217-422-6100
Fax Number
833-784-5326
person
Provider Business Mailing Address Details
Address
1770 E Lake Shore Dr Ste 105
City
State
Zip
62521-3800
Phone Number
217-422-6100
Fax Number
833-784-5326
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Internal Medicine
Speciality
Cardiovascular Disease
Taxonomy
License No.
209014278 (Illinois)
Definition
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.
person
Provider's Taxonomy Details 2
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
License No.
209.014278 (Illinois)
Definition
Definition to come...
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