Search › Illinois › 363LF0000X
Deanna Wallace, NP
NPI 1609222579 · on the registry since 2016
Practice
- Address
- 611 W Park
Fapc
Urbana, IL 61802 - Phone
- (217) 902-6954
- Fax
- (217) 902-7711
- Clinicians at this address
- 15
Additional practice sites
- 1770 E Lake Shore Dr Ste 105, Decatur, IL
- 1800 E Lake Shore Dr, Decatur, IL
Registry record
- Primary taxonomy
- 363LF0000X
363LF0000X
- Also registered as
- 207RC0000X
- Licence states on file
- IL
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2024-12-31
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois