Individual
CHARLESETTA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CNM
Contact information
Practice address
2111 E OAKLAND AVE STE B, BLOOMINGTON, IL 61701-5783
(309) 808-3068
Mailing address
5100 W BRADFORD WOODS CIR APT T, PEORIA, IL 61615-8978
(309) 357-0768
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
209033647
IL
Other
Enumeration date
10/30/2025
Last updated
10/30/2025
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