Individual
SHEREECE NICHOLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, AGPCNP-BC
Contact information
Practice address
1 MEMORIAL DR, ALTON, IL 62002-6722
(618) 463-7240
Mailing address
660 MASON RIDGE CENTER DR STE 300, SAINT LOUIS, MO 63141-8512
(314) 448-3791
(636) 996-7658
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209017027
IL
363LA2200X
Adult Health Nurse Practitioner
2017038282
MO
363LA2200X
Adult Health Nurse Practitioner
209017027
IL
Other
Enumeration date
10/27/2017
Last updated
09/25/2025
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