Individual
DEANNA WALLACE
Active
Individual
DEANNA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
209.014278
IL
363LF0000X
Family Nurse Practitioner
Primary
209014278
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
$$$$$$$$$
—
IL
01
—
P01657319
RAILROAD
IL
Enumeration date
05/10/2016
Last updated
12/31/2024
Update your record
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