Individual
LOUWANNA MARIE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
112 W MADISON AVE, CHRISMAN, IL 61924-1118
(217) 269-2394
(217) 269-2438
Mailing address
112 W MADISON AVE, CHRISMAN, IL 61924-1118
(217) 269-2394
(217) 269-2438
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
IL
Other
Enumeration date
03/16/2007
Last updated
07/08/2007
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