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Donald Wallace
NPI 1467888537 · on the registry since 2013 · sole proprietor
Practice
- Address
- 3003 Pershing Ct Ste 101
Decatur, IL 62526 - Phone
- (217) 330-9654
Registry record
- Primary taxonomy
- 237700000X
237700000X
- Also registered as
- 237700000X
- Licence states on file
- MO, IL
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2021-07-22
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