CHARLESETTA WALLACE

BLOOMINGTON, IL
NPI1114896032
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy367A00000X Advanced Practice Midwife
(Licence: IL  209033647)
Enumeration Date2025-10-30
Last Update Date2025-10-30
Business Address
CHARLESETTA WALLACE APRN, CNM
2111 E OAKLAND AVE STE B
BLOOMINGTON, IL 61701-5783
Phone number: 309-808-3068
Mailing Address
CHARLESETTA WALLACE APRN, CNM
5100 W BRADFORD WOODS CIR APT T
PEORIA, IL 61615-8978
Phone number: 309-357-0768
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