Kendall E Wallace
Nurse Practitioner
611 W Park St
Urbana
, Illinois 61801-2529
Kendall E Wallace
Nurse Practitioner
611 W Park St
Urbana
, Illinois 61801-2529
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About
Features
Specialties
- Nurse Practitioner
Languages spoken
- English
Location
First Address
- Kendall E Wallace
- 611 W. Park St. Fapc
- Urbana, IL
- Zip : 61801
- Phone :
Second Address
- Kendall E Wallace
- 611 W Park St
- Urbana, IL
- Zip : 61801-2529
- Phone : (217) 383-3311
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FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | 209017908 | IL |
National Provider Identifier
| NPI | 1003391061 |
|---|---|
| Provider Name | Kendall E Wallace |
| First Address | Urbana, IL 61801 |
| Second Address | Urbana, IL 61801-2529 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 26/09/2018 |
| Last Update Date | 26/09/2018 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.