Provider Type Icon

LIZABETH WALLACE NPI 1417019084


NPI Information

NPI: 1417019084
Provider Name: LIZABETH WALLACE
Classification: Nurse Practitioner - 363L00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
420 NE GLEN OAK AVE
PEORIA, IL
ZIP 61603
Phone: (309) 655-2343
Get Directions

Lizabeth Wallace is a nurse practitioner in Peoria, IL. The provider is (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. Lizabeth Wallace NPI is 1417019084. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

420 NE GLEN OAK AVE
PEORIA, IL
ZIP 61603-105
Phone: (309) 655-2343
Fax: (309) 655-3948

The NPI 1417019084 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 12/13/2006 and was last updated on 4/20/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1363L00000XNurse Practitioner0411285741-209004409ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1Q75702MEDICARE UPIN
2207594001OTHERILLINOISMEDICARE INDIVIDUAL ID/K35369 DEACTIVATED
3K35369MEDICARE ID-TYPE UNSPECIFIEDILLINOISINDIVIDUAL #
4207594MEDICARE ID-TYPE UNSPECIFIEDILLINOISGROUP #

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.