Individual
SARA S WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP
Contact information
Practice address
2300 N EDWARD ST, DECATUR, IL 62526-4163
(217) 876-4200
(217) 876-4209
Mailing address
2300 N EDWARD ST, DECATUR, IL 62526-4163
(217) 876-4200
(217) 876-4209
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
209029068
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041462573
RN LICENSE
IL
Enumeration date
01/31/2024
Last updated
09/25/2024
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