Wallace, Deanna

Wallace, Deanna is an individual health care provider with primary practice located at 1770 E Lake Shore Dr Ste 105 , Decatur IL 62521-3800. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Cardiovascular Disease, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Wallace, Deanna can be contacted via phone (217) 422-6100.

Contact Information

Primary practice address
1770 E Lake Shore Dr Ste 105 Decatur IL 62521-3800
Phone: (217) 422-6100
Fax: (833) 784-5326
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 209.014278 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 209014278 Illinois

Profile Details

NPI number 1609222579
LBN Legal business name Wallace, Deanna
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date May 10th, 2016
Last updated Dec 27th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609222579 NPPES
Illinois Other P01657319 RAILROAD

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