NPI 1114896032

Charlesetta Wallace, APRNCNM

Practitioner Advanced Practice Midwife Bloomington, IL

Practice location

Address: 2111 E Oakland Ave STE B, Bloomington, IL 61701-5783
Phone: (309) 808-3068
Mailing address: 5100 W Bradford Woods Cir APT T, Peoria, IL 61615-8978

Registered specialties

Advanced Practice Midwife Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 367A00000X Licence 209033647 (IL)

Other Advanced Practice Midwife providers in Illinois →

Registry record

NPI: 1114896032
Entity type: Individual
Sex (as registered): Female
NPI issued: 30 Oct 2025
Record last updated: 30 Oct 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.