DEANNA WALLACE

DECATUR, IL
NPI1609222579
Former NameDEANNA BROWN
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363LF0000X Nurse Practitioner, Family
(Licence: IL  209014278)
Additional Taxonomies207RC0000X Internal Medicine, Cardiovascular Disease
(Licence: IL  209.014278)
Enumeration Date2016-05-10
Last Update Date2021-12-27
Business Address
DEANNA WALLACE NP
1770 E LAKE SHORE DR STE 105
DECATUR, IL 62521-3800
Phone number: 217-422-6100
Mailing Address
DEANNA WALLACE NP
1770 E LAKE SHORE DR STE 105
DECATUR, IL 62521-3800
Phone number: 217-422-6100