Individual
JAMI MICHELLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
3525 N UNIVERSITY ST, PEORIA, IL 61604-1324
(309) 886-9172
Mailing address
PO BOX 9727, PEORIA, IL 61612-9727
(309) 886-9172
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209012991
IL
Other
Enumeration date
07/31/2015
Last updated
04/23/2025
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