Individual
MRS. LINDA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN RN
Contact information
Practice address
1835 KINGHIGHWAY, WASHINGTON PARK, IL 62204
(618) 482-7922
(618) 482-7881
Mailing address
1835 KINGHIGHWAY, WASHINGTON PARK, IL 62204
(618) 482-7922
(618) 482-7881
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
209003499
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209003499
LICENSE
IL
Enumeration date
10/05/2006
Last updated
09/12/2018
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