Most Relevant Information
Provider Data
| NPI Number: | 1003391061 |
| Provider Name: | KENDALL E WALLACE APRN |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 209017908 |
Most Important Dates
| Enumeration Date: | 09/26/2018 |
| Last Updated: | 04/04/2024 |
Provider Practice Location
611 W PARK ST
URBANA
IL
618012529
Practice Location Phone/Fax
| Phone: | 2173833311 |
| Fax: |
Provider Mailing Location
611 W PARK ST
URBANA
IL
618012501
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |