Lizabeth Wallace

NPI #1417019084 in Peoria, Illinois

Provider Information

NPI Number
1417019084
Entity Type
Individual
Name
Lizabeth Wallace
Gender
Not Specified
Sole Proprietor
No
Primary Specialty
Nurse Practitioner
Enumeration Date
Dec 13, 2006
Last Updated
Apr 20, 2009

Practice Location

Address
420 NE GLEN OAK AVE
City
Peoria
ZIP Code
61603-3105
Phone
(309) 655-2343

Specialties & Taxonomy Codes

Specialty
Nurse Practitioner

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