Lizabeth Wallace in Peoria - Nurse Practitioner
Lizabeth Wallace - NPI 1417019084
Lizabeth Wallace is a Nurse Practitioner in Peoria, Illinois. Lizabeth Wallace practices all healthcare services and medical treatments related to Nurse Practitioner. The NPI Number for Lizabeth Wallace is 1417019084. The last update date is 2009-04-20.
Lizabeth Wallace's current location address is 420 Ne Glen Oak Ave, Peoria, Illinois. You can contact this provider via phone number 3096552343 and fax number 3096553948. The mailing address for Lizabeth Wallace is 420 Ne Glen Oak Ave, Peoria, Illinois. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Lizabeth Wallace |
|---|---|
| Address | 420 Ne Glen Oak Ave, Peoria, Illinois |
| Phone Number | 3096552343 |
| Fax Number | 3096553948 |
| Sole Proprietor | N |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1417019084 |
|---|---|
| Provider Enumeration Date | 2006-12-13 |
| Last Updated Date | 2009-04-20 |
Provider Mailing Address Detail
| Address | 420 Ne Glen Oak Ave |
|---|---|
| City | Peoria |
| State | Illinois (IL) |
| Post Code | 616033105 |
| Phone Number | 3096552343 |
| Fax Number | 3096553948 |
Provider's Primary Taxonomy Detail
| Speciality | Nurse Practitioner |
|---|---|
| Taxonomy | 363L00000X |
| Licence No | 0411285741-2 |
|
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 certifi |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 207594001 | IL | MEDICARE INDIVIDUAL ID/K35369 |
Post Comment/ Review Below
What is the unique identification code assigned to Lizabeth Wallace by the Centers for Medicare & Medicaid Services?
The Lizabeth Wallace has been issued the NPI (National Provider Identifier) 1417019084. This 10-digit code serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you provide the complete physical address where Lizabeth Wallace is located?
The Lizabeth Wallace is situated at the following address: 420 Ne Glen Oak Ave, Peoria, IL, 616033105.
What is Lizabeth Wallace's specialized field of practice, and what is the corresponding taxonomy classification code?
The Lizabeth Wallace's area of specialization is Nurse Practitioner, and the corresponding taxonomy code that categorizes this field of practice is 363L00000X.
When was the Lizabeth Wallace's 1417019084 issued?
The Lizabeth Wallace's 1417019084 was issued on 2006-12-13.
When was the information regarding Lizabeth Wallace, such as address, specialty, and other details, most recently verified or confirmed to be accurate?
The information pertaining to Lizabeth Wallace, including its address, specialty, and other relevant details, was most recently verified or confirmed to be accurate on 2009-04-20.
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