Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1417019084 Individual Practitioner Female Practitioner

Lizabeth Wallace

Nurse Practitioner • Peoria, IL

Professional Overview & Biography Verified Profile Summary

Lizabeth Wallace is a registered healthcare professional specializing in Nurse Practitioner in Peoria, IL. Practice services are available at 420 NE GLEN OAK AVE under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

420 Ne Glen Oak Ave

Peoria, IL 616033105

Telephone 3096552343
Fax 3096553948
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Nurse Practitioner in Peoria, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.1 Yrs
State Avg: 10.4 Yrs
Regional Practice Density
182 Specialists

Practicing in Peoria, IL (4929 Statewide)

Telehealth Adoption Rate
29.1% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Nurse Practitioner Primary Specialty

NUCC Taxonomy Code: 363L00000X

State License IL 0411285741-209004409

(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.

Additional State Medicaid & Healthcare Payer Identifiers

Commercial Insurance / Payer ID Medicare Individual Id/k35369 Deactivated
207594001 (IL)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

9 Associated Practitioners
Sandra Peach , APN

Nurse Practitioner

NPI 1003268897

Advanced Practice Nurse

NPI 1003445933

Doctor of Medicine (M.D.), Master of Public Health, Certified Athletic Trainer

Dr. Charles Aprahamian , MD

Surgery - Pediatric Surgery

NPI 1033323902

Doctor of Medicine (M.D.)

Dr. John Livingstone , MD

Orthopaedic Surgery

NPI 1215427992

Doctor of Medicine (M.D.)

Jennifer Nelson , APN

Nurse Practitioner

NPI 1336546969

Advanced Practice Nurse

Taylor Milsteadt , APRN, CNP

Nurse Practitioner - Family

NPI 1548118391

Advanced Practice Registered Nurse, Certified Nurse Practitioner

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active April 20, 2009

NPI status registered as active in NPPES database

📍
Updated Practice Location April 20, 2009

Registered at 420 NE GLEN OAK AVE, PEORIA, IL 616033105 (Tel: 3096552343)

📍
Updated Business Mailing Address April 20, 2009

Registered at 420 NE GLEN OAK AVE, PEORIA, IL 616033105 (Tel: 3096552343)

👤
Provider Name / Credentials Updated April 20, 2009

Recorded as LIZABETH WALLACE

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) April 20, 2009

Nurse Practitioner (License #0411285741-209004409 in IL)

🟢
Initial NPI Registration & Enumeration December 13, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1417019084
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: December 13, 2006
Last Update: April 20, 2009
Sole Proprietor: No

Mailing Address

420 Ne Glen Oak Ave

Peoria, IL 616033105

Phone: 3096552343

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.