DR. Dane C Wallace, NURSE PRACTITIONER
NPI #1528787744 in Edwardsville, Illinois
Provider Information
- NPI Number
- 1528787744
- Entity Type
- Individual
- Name
- DR. Dane C Wallace, NURSE PRACTITIONER
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Nurse Practitioner - Family
- Credential
- NURSE PRACTITIONER
- Enumeration Date
- Aug 22, 2022
- Last Updated
- Nov 6, 2023
Practice Location
- Address
- 529 HILLSBORO AVE
- City
- Edwardsville
- State
- Illinois
- ZIP Code
- 62025-1864
- Phone
- (217) 621-8675
Specialties & Taxonomy Codes
| Specialty |
|---|
| Nurse Practitioner - Family — Family |
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