Linda Wallace, APN RN
Individual provider Active NPI Specialist · Washington Park, IL
NPI 1225124167 · NPPES record last updated Sep 12, 2018
Key facts
- NPI
- 1225124167
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 209003499 (IL)
- Practice address
- 1835 Kinghighway
Washington Park, IL 62204 - Phone
- (618) 482-7922
- Fax
- (618) 482-7881
- NPI assigned
- Oct 5, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Registered Nurse
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern Illinois Regional Wellness Center | Past | Accepting new patients | |
| Southern Illinois Regional Wellness Center | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 209003499 | IL | Yes |
Addresses
Primary practice location
1835 Kinghighway
Washington Park, IL 62204
Mailing address
1835 Kinghighway
Washington Park, IL 62204
Phone (618) 482-7922
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 209003499 | Other | IL | LICENSE |
Other providers in Washington Park, IL
- Michael Lee Schaltenbrand
- Scott Christopher Schultz
- Southern Il Regional Wellness Center
- Southern Illinois Regional Wellness Center
- Steven Lyle Wagner
All providers in Washington Park, IL · Specialist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 12, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.