Search › Illinois › 363LF0000X
Dane Wallace, NURSE PRACTITIONER
NPI 1528787744 · on the registry since 2022 · sole proprietor
Practice
- Address
- 529 Hillsboro Ave
Edwardsville, IL 62025 - Phone
- (217) 621-8675
Registry record
- Primary taxonomy
- 363LF0000X
363LF0000X
- Also registered as
- 363LF0000X
- Licence states on file
- IL, MO
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2023-11-06
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