Individual
BETHANY WALLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1200 W LOUCKS AVE, PEORIA, IL 61604-2604
(309) 306-7421
Mailing address
901 MCCLINTOCK DR STE 202, BURR RIDGE, IL 60527-0872
(630) 655-6748
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APN0000026872
TN
Other
Enumeration date
01/15/2020
Last updated
07/30/2025
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