Individual
SHELBY L. WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
8600 STATE ROUTE 91 STE 250, PEORIA, IL 61615-7831
(309) 692-5393
Mailing address
8600 STATE ROUTE 91 STE 250, PEORIA, IL 61615-7831
(309) 692-5393
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209-019301
IL
Other
Enumeration date
04/18/2019
Last updated
04/18/2019
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